Story Nursing Theory

1 January 2017

Story Theory is a middle-range theory put forward by Mary Jane Smith and Patricia Liehr in 1999. They believe that stories are an essential part of nursing practice.

They believe that stories are just as important to diagnose and treat as the physiologic bodily responses of the patient. In fact, often it is the stories that clarify and give meaning to the measurements of physiologic response. Smith and Liehr posit that all nursing encounters take place within the framework of a story.Story Theory proposes that story is a narrative happening wherein a person connects with self-in-relation through nurse-person intentional dialogue to create ease. (Smith & Liehr, 2005) Ease occurs amid accepting the whole story as one’s own. This is a process of attentive embracing the intricacy of one’s situation. The theory is based on three concepts that are clearly identified and defined.

The first is intentional dialogue which is defined as “the central activity between nurse and person that brings story to life; it is querying emergence of a health challenge story in true presence.

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(Smith & Liehr, 1999) The second concept is connecting with self-in-relation. This is defined as “an active process of recognizing self as related with others in a developing story plot uncovered through intentional dialogue. ” (Smith & Liehr, 1999) Creating ease is the third concept. It is defined as “remembering disjointed story moments to experience flow in the midst of anchoring. ” (Smith & Liehr, 1999) These definitions are fairly simple and concise. Although self-in-relation is a new term coined by the theorists, like intentional dialogue and creating ease, it is a very explicit concept.

Even without reading the stated definitions and explanations, one readily gets a good sense of what they mean. The concepts themselves readily convey their meaning. This is one of the theory’s strength. Secondary supporting definitions are given. For example, the theorists offer a definition of ‘flow’ as “an experience of dynamic harmony” and ‘anchoring’ as “an experience of comprehending meaning. ” (Smith & Liehr, 1999) This clarifies potentially vague concepts and makes the theory less general. The concepts are presented in a logical, sequential arrangement both in relationship to each other and overall structure of the theory.

The nurse engages in a purposeful dialogue with the patient and family about his illness- what has brought him to this encounter; she is actively exposing the patient’s personal history ( where the patient has been, where he is now, and where is he going ). She facilitates reflective awareness where the patient is encouraged to share physical bodily experiences, thoughts and feelings. The story comes together and culminates in the patient and the nurse understanding meaning for the patient. By exploring the bigger picture context is given to the patient’s current condition.In other words the concepts represent a beginning, middle, and an end, just like a story. In this way the concepts are interdependent and fit succinctly within the walls of the theory. The diagrammatic representation of Story Theory is simple and incorporates the three concepts of the theory.

It uses three cascading ellipses to show a working relationship among the concepts, the nurse, and the patient. Story theory with method. (Smith & Liehr, 2005) Intentional dialogue is highlighted and positioned in the center. This speaks to its centrality in the theory.It is the medium through which the patient and the nurse engage to connect with self-in-relation and to create ease. The diagram includes the method dimensions associated with understanding and applying each concept. The nurse interacts with a person through intentional dialogue about a complicating health challenge, where connecting with self-in-relation follows as the developing story-plot emerges through story sharing.

As the storyteller makes obvious what may have been unspoken, moments of ease foster movement toward resolving the health challenge. Smith & Liehr, 1999) The diagram is effective in that it encompasses the theory’s concepts in an uncomplicated layout. This structure is consistent with the principles of the theory. The ellipses are connected just as the concepts are interrelated and interdependent. The broken lines throughout signify that actors and concepts share a dynamic relationship and interchangeably affect the practice environment. Creating ease is represented as a smaller ellipsis. An explanation is not given by the theorists.

One reason could be that although this concept is important, Smith and Liehr, 1999 point out that it is sometimes elusive.As stated previously, Story Theory is a very simple practice theory. As shown the main concepts are combined to give the theory its’ meaning and efficacy. There are two main relationships expressed. The primary one is that between the nurse and the patient and family. This relationship is created as a consequence of a health challenge, and involves developing the patient’s story. The patient as the story teller is respected and the nurse’s role is to support and guide the patient toward discovering what has meaning.

It is a trusting relationship that involves the nurse actively listening without making assumptions or judgments. The second relationship is the patient’s relationship with self. It is the outcome of intentional dialogue with the nurse. The patient having reflected on his past and gains a better understanding of the present. The patient recognizes and accepts himself and his place in the world. These two relationships are active, positive, and exploratory. The provide information for the nurse, patient family and other clinicians involved in the patient’s care.

They are aimed at helping the patient and family overcome or cope with a health challenge so they can move forward. Story Theory describes the patient’s history of illness and health, and explains how his current situation fits into the bigger picture. It also describes how this is necessary for the patient and family to cope. In this way it is somewhat predictive as it states that if the nurse guides the patient to reflect, he will connect with his past and present circumstance and consequently will be able to move forward. In this way the theory imparts understanding and creates meaning for the patient.The theory has a specific purpose for nursing. It is geared at helping sick patients and families understand their illness and how to cope with it.

It uses storytelling as a specific path for achieving this. This is definitely purposeful for nursing in that allowing a person to connect with self-in-relation is a component of caring. It allows for good history taking and for illness to be seen through the eyes of the patient. It allows for what is important to the patient to be uncovered. This will be incorporated into the treatment plan, making it more patient-focused.This will lead to increased compliance and effectiveness. The theory can also be used for a person experiencing a range of health challenges.

Whether it is an unexpected pregnancy, anxiety related to a new job, or a diagnosis of cancer. In each case the person has a story to tell. This gives Story Theory very broad application across the different practice specialties. Story Theory can also be useful for research. It is guided by the phenomenological method. It helps to uncover how people make sense of specified life situations. By gathering stories the research yields nowledge and understanding about lived experiences.

This can be especially useful in generating emancipatory knowledge. A similar methodology was used by Paulo Freire when he explored illiteracy among Brazilian sugar cane workers in a society where literacy was required to vote. (Butts & Rich, 2011) Consequently, Story Theory can be useful for other disciplines. It has proven useful for the discipline of education. It was used by a university to successfully create an innovative honors level nursing course. (Carpenter, 2010) Story Theory is an important contribution to nursing.It incorporates the metaparadigms of the discipline.

It shows how interactive and central they are. The patient as the person experiencing a health challenge tells his story to the nurse. The patient’s story is predicated on his view of his health or lack thereof, and his environment – past and present. Nursing occurs when the nurse guides the patient to reflect on, and understand his life circumstances so as to make sense of, and accept his current situation. I like the theory for its simplicity and holistic approach to practice.However, there are two unresolved issues that could decrease the efficacy of the theory. It is possible that the patient might not accept his present condition and is not able to move forward.

For example, someone who is young and lives a healthy lifestyle might never be able to understand, accept, and cope with a diagnosis of terminal cancer. Similarly, what matters most to the patient might be totally unrelated to the health challenge at hand. This could pose a real dilemma. References Butts, J. B. , & Rich, K. L.


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