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Heeding calls to expand the resources and approaches to psychologically support injured athletes, this study explored the applied value of socio-cultural sports injury narratives for athletes, coaches, and practitioners. Informed by narrative inquiry and pedagogy, six evidence based sports injury narratives were shared and discussed with 69 elite participants (i.e., athletes, coaches, and practitioners) across 11 focus group interviews. A reflexive thematic analysis identified five themes: (1) Forewarned is Forearmed, (2) Building Blocks to Constructing Meaning(s), (3) Fostering Interpersonal Connections, (4) A Common Language, and (5) Promoting Communal Responsibility. Overall, these themes advance empirical understandings of how narratives can inform professional practice by supporting injured athletes across personal (e.g., meaning making), social (e.g., enhancing interpersonal relationships), and cultural (e.g., promoting communal responsibility) levels. Lay Summary: Findings highlight the applied value of socio-cultural sports injury narratives for professional practice. Not only can they assist athletes in navigating their future injury experiences and making sense of their past and current injury experiences, but they can also foster dialogue around injured athletes' experiences, create more interdisciplinary conversations, and promote greater communal responsibility. PRACTICAL IMPLICATIONS: Sports injury narratives act as resources that enable athletes to make sense of, construct, and communicate their own injury story. Sport injury narratives enhance relationships between athletes and support networks by facilitating empathy and understanding and promoting more communal dialogue. Sports injury narratives promote a broader duty of care toward injured athletes by raising awareness of how broader socio-cultural contexts constrain and/or enable their experiences. [ABSTRACT FROM AUTHOR]

Background: Black birthing people in the United States are disproportionately impacted by maternal mortality and more frequently report physical and verbal mistreatment during intrapartum care. Birth plans for prenatal and postpartum care promote autonomy and agency but have not been used as tools to address disparities in perinatal care. Methods: We reviewed the literature on the use of birth plans and communication in the pregnancy care setting. We provide an expert analysis and a recommendation for a comprehensive birth plan that incorporates patient preferences and individualizes patient risks as a communication tool. Results: In this expert opinion we outline how an equity birth plan can address social determinants of health, promote respectful communication and prioritize attention to patient narratives. This instrument can be used to address systemic problems that result in health inequities on a community, provider and institutional level. Conclusions: A birth plan with attention to equity serves as a new paradigm for care which can empower patients and reduce racial inequities in perinatal and postpartum outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Narrative Medicine complements the clinically centered approach, which focuses on the analytical and sanitary aspects, with the illness- and disorder- centered models, which deal respectively, with personal coping and social perception of a condition. Hypermobile Ehlers- Danlos Syndrome and Behçet's Disease are two rare multisystemic chronic disease experienced a myriad of clinical symptoms, psychological distress, and poor quality of life. The purpose of this report is to describe application of a multidisclipinary rehabilitation intervention according to the narrative medicine. Case description and Intervention: a 35-year-old woman with a 23-year history of Hypermobile Ehlers-Danlos Syndrome and Behçet's Disease was admitted. A multimodal rehabilitation approach was implemented and described through the patient's feelings and expected short-, medium-, and long- terms goals. Moreover, she reported her feeling with periodical interview by her therapist. History patient: The patient was seen for 32 weeks. A decreased pain, as well as improved function was recorded immediately post-intervention. Conclusion: Narration is not just an interpretation of the illness experience, but the result of reshaping the interpretations of the story that both patient and health professional. This discipline provides enrichment of care, especially when combined with rehabilitation in chronic disease, by paying attention to and using even in the therapeutic phase the stories of patients, family and health care personnel, giving the opportunity to define a tailored effectiveness rehabilitation approach at the light of the different points of view of the subjects. IMPLICATIONS FOR REHABILITATION: Narrative Medicine might play a key role in an interpretation of the illness experience to implement a multidisciplinary tailored rehabilitation approach. Narrative Medicine can help understand discomfort and difficulty associated with rehabilitation activities, thereby enhancing patient motivation and participation in interdisciplinary care. The Ehlers–Danlos Syndrome is a heterogeneous group of heritable connective tissue disorders representing a challenge in rehabilitation. Behçet's Disease is a rare multisystemic chronic disease experiencing an impaired function and a poor quality of life. A patient-oriented multimodal rehabilitation showed to be a useful approach in the case with both diseases, with a reduction of pain and an improvement of functioning. [ABSTRACT FROM AUTHOR]

In this paper, taking a cue from the image provided by Walter Benjamin, I argue that the work of the psychiatrist can be compared to that of the ragpicker who collects what others consider to be 'waste', rescuing it from oblivion and transforming it into a key resource for treatment. I review two 'logics of discovery'- phenomenologically inspired structural psychopathology and that of narrative psychopathology - whose purpose is to complement mainstream diagnostic approach based on 'ticking boxes'. I try to identify the shortcomings of these two methodologies, in particular the confirmation bias that can cause selective inattention to anything that does not fit into the expected structure or narrative. I highlight the heuristic importance of these 'fragments' that are in danger of remaining on the fringes of the clinician's attention who is too focused on 'making ends meet,' showing how in certain psychopathological conditions - e.g. early schizophrenia and borderline personality disorder, marked by fragmentation - inattention to fragments can impede understanding and treatment. I argue for the importance in psychiatry of an 'emergentist' logic of discovery, of a kind of psychopathological knowledge 'co-produced' with patients, and of fragment-oriented listening in order not to lose the richness of patients' own accounts. [ABSTRACT FROM AUTHOR]

The article focuses on the importance of restoring trust in patient-provider relationships by incorporating humanistic approaches in healthcare education, such as using literature, theater, and the arts. It argues that these methods can enhance understanding of patients' experiences and foster empathy, which are essential in rebuilding trust that may have been lost due to systemic pressures, sociocultural conflicts, or past healthcare crises like the COVID-19 pandemic.

This study examines providers' perceptions of provider-patient communication in reproductive endocrinology and infertility (REI) practices. Grounded in narrative medicine, we interviewed six REI providers about their experiences providing fertility care. REI providers crafted a narrative of bearing witness by (1) situating personal and professional self in REI narratives, (2) sharing news as important medical moments, and (3) cultivating affiliation between provider and patient. These findings offer insight into the power of narrative medicine in fertility care, the role of emplotment in narrative sense-making, and the emotional labor associated with information delivery in REI treatments. We offer several recommendations for how patients and providers can improve communication experiences in REI. [ABSTRACT FROM AUTHOR]

Over the past three decades, "lived experience" designated roles in mental health services in Australia have increased. However, the lived experience of staff in roles not designated in this way is often hidden or unacknowledged. This qualitative study included 33 participants employed in a range of roles at two Victorian mental health services, including 10 social workers. Interviews explored staff perspectives regarding the sharing of lived experience by staff with colleagues and supervisors. Concept analysis identified conflicting ways of thinking about lived experience, which influenced when and how staff shared and how they responded to sharing by other staff. These findings suggest the need to explicitly address the purpose and value of sharing lived experience in the mental health workplace, to better support staff and service users. Recommendations for social workers and their colleagues, working at all levels of the mental health system, are provided. IMPLICATIONS The perspectives and experiences of mental health service staff suggest room for improvement in the valuing and inclusion of staff with lived experience, which may have benefits for service-user experiences of support. Promoting the value of sharing lived experience to reflective-practice and service reform is consistent with core social work values and, thus, the responsibility of all social workers, supervisors, and educators. [ABSTRACT FROM AUTHOR]

In Rita Charon's account of narrative medicine, empathy seems to be an essential element of the clinical relationship. However, empathy has not received much attention, which I believe is problematic. First, I show that not only is there no clear definition of what empathy is, but that this conceptual gap creates ambiguity about its role in the practice of narrative medicine. Second, I argue that certain passages in Charon's work seem to implicitly characterize empathy as a combination of cognitive empathy, affective empathy, and sympathy, and that its inclusion in the practice of narrative medicine can be problematic. Third, following Dan Zahavi, I argue that a phenomenological account of empathy not only seems most compatible with the practices, values, and theoretical framework of narrative medicine, but is also capable of resolving the problems posed by alternative definitions of empathy and the ambiguity about the role of empathy in narrative medicine. [ABSTRACT FROM AUTHOR]

While innovation is known to catalyse solutions to global sustainable development challenges, lack of engagement from stakeholders during conceptualisation and development may influence the degree of success of implementation. This paper presents a complete and novel engagement methodology, developed from value led business modelling approaches, for working with multi-sector stakeholders. The methodology can be used to determine barriers and facilitators to clinical practice innovations or translational research, within a country-specific context. The approach has then been applied in the Cambodian prosthetics and orthotics sector to provide a practice-based exemplar application of the framework. This approach seeks to ensure the suitability and sustainability of clinical practice and research programmes being implemented within a complex ecosystem. A theoretical basis, drawn from academic and business innovation sectors, has been consolidated and adapted for practical application to design, direct, and inform initiatives in low resource settings. The methods presented provide a way to both develop and articulate the mission, vision, and goals of any proposed change, and to effectively communicate these with stakeholders in a way that engages the personal and professional values that exist in their ecosystem. It provides a structured process through which meaningful conversations can happen, and a basis for relationship management with key stakeholders; intrinsic to enable a sustained legacy from research and development. The engagement from stakeholders during conceptualisation and throughout development can determine the success, or not, of any implementation and scale of innovation. This paper presents a conceptual stakeholder-led engagement methodology, developed from value led business modelling approaches, for determining barriers and facilitators to translational global healthcare research in a country-specific context, in this case the Cambodian prosthetics and orthotics sector. Subsequent research and development work in this area needs to carefully manage and negotiate influencing factors identified through the application of the described methodology, to ensure initiatives (whether research or wider national development work) are sustainable and successful. [ABSTRACT FROM AUTHOR]

Objective: To explore the effect on empathy skills of integrating narrative medicine instruction into clinical internship undergraduate medical education. Methods: One hundred clinical undergraduate students who were transferred to gynecology and obstetrics in 2016 were selected as subjects and divided into two groups. The control group adopted the traditional practice teaching mode, while the experimental group adopted a narrative medicine integrated with traditional teaching mode. The impact of the narrative medicine course was evaluated using the Davis Empathy Scale, and the students' acceptance of the course was investigated using a self-developed questionnaire. Results: After completion of the rotation, the empathy scores of the experimental group were higher than those of the control group (p < 0.05). Students in the experimental group rated the integration of narrative medicine into the internship class highly, and most students thought that the narrative medicine course was of great benefit with respect to the humanistic quality of medical teaching. Conclusion: The application of narrative medicine teaching in the clinical practice teaching of obstetrics and gynecology promoted students to improve their empathy ability. [ABSTRACT FROM AUTHOR]

Background: Narrative medicine can serve as a tool to empathize with human beings' predicament and suffering. The research intended to examine whether the use of narrative medicine to form an empathetic connection could bring any positive impacts on health professions students. Methods: A two-group quasi-experimental design was adopted to examine whether the intervention of narrative medicine to form an empathetic connection could demonstrate differences between the experimental group (35 students) and the control group (32 students) with regard to professional identity, self-reflection, emotional catharsis, and reflective writing competency. These 67 participants were health professions students in a medical university (mean age = 20.02; SD = 0.23), with varied majors in health disciplines. The 16-week intervention was the use of narrative medicine to form an empathetic connection with those suffering, via the three stages of narrative medicine: attention → representation → affiliation. The quantitative instruments included a professional identity scale (PIS-HSP), a reflective thinking scale (RTS-HSP), and an emotional catharsis scale (ECS-IN), as well as an analytic reflective writing scoring rubric (ARWSR-HSP). To triangulate the quantitative results, the study also used the student interviews. The SPSS software was used to analyze the data. Results: The quantitative results demonstrated that the narrative medicine-based intervention could bring positive effects on the health professions students. After going through the intervention, the students in the experimental group had stronger professional identity, a higher reflective thinking level, more emotional catharsis, and greater improvement in reflective writing competency than those not receiving the intervention, though some subscales not reaching statistical significance. Conclusion: This research results proved that the use of narrative medicine to form an empathetic connection could bring positive impacts on health professions students regarding professional identity, self-reflection, emotional catharsis, and self-reflective writing competency. [ABSTRACT FROM AUTHOR]

Burnout in pediatric residents is widespread. Certain factors are associated with decreased burnout, such as empathy, self-compassion, mindfulness, and resilience, while perceived stress is associated with increased burnout. Narrative medicine may reduce burnout by its impact on protective and exacerbating factors and can be an active tool to promote wellness. The objective of this pilot study was to evaluate immediate and delayed benefits of a longitudinal narrative medicine intervention for pediatric residents using qualitative and quantitative measures. We designed a voluntary longitudinal narrative medicine intervention implemented via Zoom teleconferencing software over five months for pediatric residents at Nationwide Children's Hospital. It consisted of six one-hour long sessions where residents engaged with literature, responded to a writing prompt, and shared their reflections. It was evaluated using open-ended survey questions and established quantitative assessment tools of well-being with validity evidence. Results were compared before the intervention, immediately after, and six months later using one-way ANOVA and multiple linear regression. Qualitative data was analyzed using thematic analysis. Twenty-two (14% of eligible) residents participated in at least one session. After the intervention, the following themes emerged for benefits to resident well-being: the ability to Build Community, have an Outlet for Self-Expression, reap Emotional and Mental Health Benefits, and work on Personal Growth. Benefits were sustained even six months later, which has not been shown previously. While there were significant qualitative findings, between all three time points, there was no change in any quantitative well-being measures. Our longitudinal narrative medicine pilot study showed meaningful sustained qualitative benefits, though no quantitative changes, in measured well-being outcomes that have been previously associated with lower resident burnout. While not a panacea, narrative medicine can be a useful strategy for residency programs to improve pediatric resident well-being even after completion of planned interventions. We used a mixed-methods approach to assess the effects of a longitudinal narrative medicine intervention on well-being in pediatric residents. Open-ended responses indicated that residents found utility in and appreciated the intervention and experienced sustained improvements in their mental and emotional health, though the sample size was likely too small to show quantitative changes in well-being measures. Narrative medicine is not a panacea, but it can be a useful tool to provide to pediatric residents to promote sustained improvements in their well-being through the framework of relationship-centered care. [ABSTRACT FROM AUTHOR]

Narrative reconstruction is a time-limited integrative therapy, originally developed in the context of post-traumatic stress disorder and adjusted for the treatment of prolonged grief disorder (PGD). It consists of exposure to the loss memory and narrating a detailed written reconstruction of it. In this paper, we describe narrative reconstruction interventions and modifications for the treatment of PGD as well as the underlying mechanisms of change including integration of the loss episode into the life narrative. A case demonstration of narrative reconstruction with a patient with PGD presented for illustration and the integrative nature of narrative reconstruction for PGD is discussed. [ABSTRACT FROM AUTHOR]

This study examines how news features (framing and the use of exemplars) can help overcome two common barriers (psychological and cognitive) impeding Black American participation in clinical trials. In an online experiment, Black participants (N = 390) viewed social media news posts varying in framing (focus on psychological vs. cognitive barriers) and use of an exemplar (present vs. absent and White vs. Black) and then responded to outcome measures including perceived message effectiveness, message attitudes, and intention to participate in clinical trials. The findings illustrate that including a racially matched (i.e. Black) exemplar improves attitudes toward clinical trial messages. Most notably, featuring a race-matched exemplar increases intention to participate in a trial when the messages discuss psychological barriers. These findings enhance our understanding of how messages can be better designed to increase Black American participation in clinical trials, thereby contributing to reducing health inequities and improving health outcomes. [ABSTRACT FROM AUTHOR]

In this autoethnographic account of my experience as a neonatal intensive care unit (NICU) mother, I bring attention to socially silenced health issues begging our acknowledgment. The lack of discourse about complications with pregnancies and births leave too many women and men shocked and traumatized by experiences that are far more common than we believe. Currently, 10 percent of pregnancies in the United States end in preterm birth, which are often accompanied by a variety of serious health conditions requiring newborns to be admitted to a NICU. Postpartum depression rates among NICU mothers are 40 percent and parents of NICU children are at high-risk for post-traumatic stress disorder. As I lived and continue making sense of this journey, narrative medicine has been a constant source of strength. My hope is that my family's story might enlarge our understandings of narrative medicine and its remarkable capacities as we live amid health challenges and learn to live with their lingering effects on our stories. Specifically, narrative medicine is a dynamic, relational experience capable of cultivating hope within contexts scattered with hardship, transformative in its immediate and long-term affective force. [ABSTRACT FROM AUTHOR]

Narrative medicine is an approach to healthcare that acknowledges the stories of patients' lives both within and beyond the clinical setting. Narrative medicine has been increasingly recognized as a promising tool to support modern educational needs in health professions training, such as interprofessional practice, while enhancing quality of care. Here, we describe the development, implementation, and application of a narrative medicine program at the University of Minnesota Phillips Neighborhood Clinic. First, in a qualitative analysis of patient stories (n = 12) we identified themes regarding the value of the storytelling experience; patients' personal journeys; and patients' experiences in healthcare and other systems. Second, an interprofessional educational activity for student volunteers (n = 57) leveraging a patient narrative was observed to be satisfactory, significantly improve attitudes toward the underserved, and enhance quality of care from the perspectives of trainees. Together, findings from the two studies imply the potential benefits of broader incorporation of narrative medicine into interprofessional service settings, for both learners and patients. [ABSTRACT FROM AUTHOR]

Problem: Diversity, Equity, and Inclusion (DEI) trainings for medical school faculty often lack self-reflective and pedagogically focused components that may promote incorporation of anti-racism and social justice into medical school curricula. Intervention: A four-session Narrative Medicine (NM) anti-racism program was designed for medical school faculty using critical race theory, phenomenology, and NM methods. Each workshop consisted of a lecture on key NM concepts and a small-group breakout session incorporating group discussion, close reading, and reflective writing. Context: This NM anti-racism program was developed and implemented in April 2021 by two medical students for faculty at an institution in the southeastern U.S. The program was supported by the Office of Inclusive Excellence at the institution and held in collaboration with the institution's medical education teaching academy. Program evaluation consisted of pre- and post-program surveys, which queried participants' previous experiences with DEI and medical humanities programs, perceptions of self-identity and privilege, and confidence in teaching concepts of anti-racism. Of the total program participants (n = 32), 19 completed both surveys (54.3%). Survey data were analyzed using bivariate testing methods and qualitative thematic analysis. Impact: Post-program surveys showed 13 (68.4%) participants felt "somewhat more" or "more" comfortable engaging in concepts of race, and 12 (63.2%) participants felt "somewhat more" or "more" comfortable including topics of race into their teaching compared to before the program. Five themes were generated following qualitative analysis: (1) the value of longitudinal narrative reflection in a small-group setting for DEI work; (2) desire to commit more time to DEI, anti-racist, and social justice work while balancing busy teaching and clinical schedules; (3) the value of storytelling in DEI and anti-racism programming; (4) an understanding of deconstructive and reconstructive work of anti-racism in medicine; and (5) an increased ability to educate and enact change through teaching, activism, and institutional cultural and policy changes. Lessons Learned: This novel NM DEI training for medical school faculty was successful in increasing comfort discussing and teaching concepts of race in the medical school classroom, while providing a uniquely reflective space for personal growth. Participation in this longitudinal reflective experience was limited by physician schedules, therefore efforts to make time to participate in similar longitudinal interventions must be undertaken. [ABSTRACT FROM AUTHOR]

More medical schools are incorporating wellness activities and the medical humanities into their curriculum. Finding implementable programming that is feasible and enjoyable is challenging. Both student participants and faculty who might facilitate programs are busy with clinical and educational responsibilities. Book club discussions in general are an activity that bring people together and expose groups to literature. In medical education, informal books clubs have been shown to increase camaraderie and expose participants to topics in medicine that they may not have encountered without the structure of the group assignment. At one large private urban medical school, all fourth year medical students were required to participate in a one-time hour-long book discussion with a faculty member one week before Match Day 2021. This paper describes the implementation of that program and discusses survey results from 179 students who broadly indicated that the books were enjoyable, the discussions were enriching, and that the program should continue for future classes of medical students. [ABSTRACT FROM AUTHOR]

This piece explores how poetry and prose can be used as an adjunct to medical education and patient care, especially in the field of psychiatry. It details the author's personal experience with spoken word poetry as a medium of communication about their own story and how this may be harnessed to tell the stories of patients as well. The piece touches on how mental health can be explored through creative writing and how this may be a useful tool for working with patients. [ABSTRACT FROM AUTHOR]

Alcoholism is a serious problem that is difficult to treat. This study investigated the effects of group counseling utilizing narrative therapy on self-esteem, stress response, and insight for alcoholism. We utilized a nonequivalent control group, non-synchronized design. Collected data were analyzed using descriptive statistics, Fisher's exact test, Chi-squared test, independent and paired t-tests, and repeated measures ANOVA. The experimental group showed significant improvements in self-esteem (F = 14.03, p <.001), stress response (F = 4.31, p <.05), and insight (F = 21.27, p <.001) after the intervention compared with the control group. Additionally, there were significant improvements in self-esteem (t = −6.32, p <.05), stress response (t = 4.93, p <.05), and insight (t = −5.02, p <. 05) within the experimental group after the intervention. Thus, narrative therapy is recommended as an autonomous regulation approach for developing strengths necessary to refrain from alcoholism. [ABSTRACT FROM AUTHOR]

Recent research has highlighted the importance of responding to trauma and promoting healing when working with participants in sensitive contexts. This article presents a new methodology for design research on health topics which combines principles from narrative medicine (health storytelling) with codesign. In this collaborative, dialogic approach, participatory action research cycles of storytelling are used to inform a process of digital codesign, positioning participants as peer researchers. The resulting prototypes (termed healing fabulations) are a new type of design artefact which captures each participant's lived experience while also extending it into a speculative future. Discussion of the methodology shows how the approach protects participant wellbeing during research on their health experiences, addresses common criticisms of digital design research, and explores the importance of visual metaphor and aesthetic in design for health. The article concludes with a discussion of the methodology's replicability and use in future research. [ABSTRACT FROM AUTHOR]

Illness models, including illness recognition, perceived severity, and perceived nature can affect treatment-seeking behaviors. Vignettes are a leading approach to examine models of illness but are understudied for substance use disorders (SUDs). We created vignettes for multiple common DSM-5 SUDs and assessed SUD illness models among college students. Seven vignettes in which the protagonist meets DSM-5 diagnostic criteria for SUDs involving tobacco, alcohol, cannabis, Adderall, cocaine, Vicodin, and heroin were pilot tested and randomly assigned to 216 college students who completed measures related to illness recognition, perceived severity, and perceived nature. MANOVAs with Scheffe post-hoc tests were conducted to examine vignette group differences on models of illness. Vignettes met acceptable levels of clarity and plausibility. Participants characterized the protagonist's substance use as a problem, a SUD, or an addiction most frequently with Vicodin, heroin, and cocaine and least frequently with tobacco and cannabis. Participants assigned to the Vicodin, heroin, and cocaine vignettes were the most likely to view the protagonist's situation as serious and life-threatening, whereas those assigned to the cannabis vignette were the least likely. Numerically more participants characterized the pattern of substance use as a problem (91%) or an addiction (90%) than a SUD (76%), while only 15% characterized it as a chronic medical condition. Illness recognition and perceived severity varied across substances and were lowest for cannabis. Few participants conceptualized SUDs as chronic medical conditions. College students may benefit from psychoeducation regarding cannabis use disorder and the chronic medical condition model of SUDs. [ABSTRACT FROM AUTHOR]

Studies show that people from traditional religious belief systems may experience relational, emotional, and psychological dysfunction related to sexual identity and behaviors. Shame that is rooted in one's understanding of oneself as a sexual being may result in dis-integration (lack of internal integrity) and feelings of disconnection from sense of self, one's body, and others. Yet research also shows that personal and communal spirituality can be a therapeutic resource for fostering mental health and relational wholeness. The theological reflections of women, BIPOC, and queer scholars provide sex-positive spiritual resources for a holistic view of the human person as embodied and enspirited, including sexuality as a foundational and integrated dimension of spirituality. This paper offers constructive recommendations for spiritual practices that may aid clients in reintegrating sexuality and spirituality, and provides therapists with a framework for helping clients identify and embrace healing practices that are informed by traditional religious categories and by contemporary spiritualities emerging outside religious institutions. We highlight spiritual connections to nonreligious practices of body and community, and conclude with guidance for clinicians to offer appropriate support and reflection for clients on this sexual-spiritual journey. LAY SUMMARY:This article offers therapists a framework for helping clients identify and embrace healing practices that are informed by both traditional religious categories and by contemporary spiritualities outside religious institutions. We also highlight spiritual dimensions of non-religious practices that contribute to a sense of sexual-spiritual wholeness. [ABSTRACT FROM AUTHOR]

We have published a model of the GP consultation where biomedical and humanistic elements of the consultation are seen as complementary and where hermeneutics, the discovery and creation of meaning, plays an integral role in enriching the conversation between clinicians and patients. The relationship between teachers and learners shows strong parallels with the relationship between practitioners and patients. We therefore explore how a similar analysis can enhance the relationship between teachers and learners and propose that hermeneutics can be particularly powerful in exploring and making explicit elements of the hidden curriculum. [ABSTRACT FROM AUTHOR]

The first wave of the COVID-19 pandemic led to high patient loads in many hospitals. However, paediatric emergency departments (EDs) saw a dramatic decrease in admissions, mainly due to the fear of contracting COVID-19 in hospitals. Moreover, paediatric EDs were required to reorganise their services rapidly to deal with the pandemic. We aimed to describe the experiences of healthcare professionals (HPs) working in a paediatric ED in Italy during the first wave of the COVID-19 pandemic through reflective practice. Twenty-six HPs (16 attending paediatricians, 5 residents, 5 paediatric registered nurses) wrote a single, comprehensive text, in which they reflected on their experiences of care during the first wave of the pandemic. The study was framed within narrative medicine as a means for reflective practice. We identified six main themes: the enemy is about to burst in and to sweep us away, raised fences against the enemy, the meaning of time, getting caught in the storm, being and staying in spaces, and the work unrecognisably transformed. Our findings reflect how profoundly HPs' lives changed, inside and outside the hospital, during the first wave of the pandemic. Narration was useful in helping HPs deal with personal issues brought on by the pandemic. [ABSTRACT FROM AUTHOR]

One essential function of autobiographical writing is to provide not an account of oneself but rather a model for others. Creating the self as a narrative object involves establishing an ambiguous intersubjective space, where complex acts of mirroring—the writer's ego imposed upon the reader, the reader's desire fulfilled within the writer's life—complicate the assessment of authenticity. This article examines how this effect is both amplified and undercut by autofictional satire in Samuel Shem's famous novel about his year-long medical internship, The House of God (1978). Considering the text in light of aesthetic theory, philosophy, and narrative medicine reveals how the novel's own form deliberately resists its reader's pursuit of an intersubjective identification. Just as The House of God's narrator establishes an identity equally disorienting and empowering, so too does the novel's deployment of competing genres and traditions use humour to blur the lines between aesthetic mimesis and social role-modeling, forcing us to reassess utilitarian and cathartic reading practices in the medical professions. In the era of COVID-19—a timewhen aspirational medical narratives have taken on new cultural power—Shem's troubled negotiation between what 'should be' and what 'is' continue to challenge how we should read. [ABSTRACT FROM AUTHOR]

In what follows, I show how the process of creating, rehearsing, and presenting a performance ethnography allows me, my family, the witnessing audiences, and readers to view performance as a productive metaphor for the lived experience of familial chronic illness. First, I join my work with ongoing scholarly conversations about performance ethnography and narrative medicine. Next, I demonstrate how to document and analyze a performance process using several principles of narrative medicine. Finally, I make a case for performance as narrative medicine as a pedagogical and medicinal practice. [ABSTRACT FROM AUTHOR]

Context: Storytelling is a powerful tool for encouraging reflection and connection among both speakers and listeners. While growing in popularity, studying the benefits of formal oral storytelling events within graduate medical education remains rare. Our research question was: could an oral storytelling event for GME trainees and faculty be an effective approach for promoting well-being and resilience among participants? Methods: We used multiple approaches to gather perspectives from physician participants (storytellers and audience members) at an annual oral storytelling event for residents, fellows, and faculty from seven academic health systems in Minnesota. Data sources included short reflections written by participants during the event, an immediate post-event survey exploring participants' experiences during the event, social media postings, and targeted follow-up interviews further exploring the themes of connection and burnout that were raised in post-event survey responses. We performed a qualitative analysis using both deductive and inductive coding to identify themes. Results: There were 334 participants, including 197 physicians. At the event, 129 real-time written reflections were collected. There were also 33 Twitter posts related to the event. Response rate for the post-event survey was 65% for physicians, with 63% of physician respondents volunteering for targeted follow-up interviews. Of those, 38% completed the follow-up interview. Themes that emerged from the multi-modal qualitative analysis included a sense of connection and community, re-connection with meaning and purpose in work, renewal and hope, gratitude, and potential impact on burnout. Conclusion: The large turnout and themes identified show how an oral storytelling event can be a powerful tool to build community in graduate medical education. Qualitative analysis from multiple sources obtained both in real-time at the event and upon deeper reflection afterwards showed the event positively impacted the well-being of participants and that oral storytelling events can be an effective approach for promoting resilience in GME. [ABSTRACT FROM AUTHOR]

Background: Despite well-known advancements in medicine, there is rather little known about the effects of patient-centered care on clinician-patient encounters. The aim of this narrative study is to explore interactive competencies in diagnostic and therapeutic encounters and intake protocols from the perspectives of physicians, nurses and medical receptionists. Methods: Three data sets including 13 participant interviews, policy documents and a website were used. Further triangulated analyses, including N-Vivo, manifest and latent, Mishler's narrative elements and Charon's narrative themes, in recursive, overlapping, comparative and intersected analysis strategies were employed. Results: A common factor affecting physicians' relationships with their clients was limitation of time. For almost all nurse participants in the study establishing therapeutic relationships meant being compassionate and empathetic. The goals of intake protocols for the medical receptionists were about being empathetic, listening attentively, developing rapport, and being polite to patients. Conclusion: Patient-centeredness has emerged as a discourse practice, with nebulous enactment of its premises in most clinical settings. The healing power of effective communication is well-known but the scientific affirmation of it is scarce. More research has to be undertaken to better define and understand the role of good narration in terms of outcomes with regards to diseases and illnesses. [ABSTRACT FROM AUTHOR]

There is a dearth of recorded lived experiences and reflections of scholars and healers grappling with the loss of their communication senses. I am assaulted by deafblindness as a result of a degenerative disease and find my world is unmade. With the loss of sight and the disappearance of hearing come dependence and despair. This personal essay looks at my poor experience at ground zero for research, writing and advocacy—combining personal memoir with other illness and disability narratives to elucidate the universality of human experience (particularly of suffering) while focussing on how carers can do better. I write of the wreckage of, repair to and transformation of my experience and tell of brief formative episodes in my history to give relatable examples of both devastation and resilience in the face of dual sensory loss. In addition, I detail how through my reading and writing I espouse the role of the deafblind researcher—pathfinding so the way can be easier for future students. This writing offers insights into the ways narrative medicine can help repair the self. We share stories, and then others can go on too. [ABSTRACT FROM AUTHOR]

Background: Physician and trainee burnout are becoming an epidemic within the medical community. Objective: This paper describes an innovative emergent curriculum that uses narrative medicine, creative activities, and group discussions to alleviate burnout. Methods: Between August 2016 and August 2019, 394 medical trainees participated in sessions that focused on themes relevant to promoting wellbeing, such as maintaining sensitivity to patients and finding balance. After the activities, trainees answered survey questions that related to the session theme and aided in reflection. Discussion: The student responses showed the program supported introspection that left students feeling less tired, more relaxed, and connected with one another. [ABSTRACT FROM AUTHOR]

This paper operationalises the theory of social practices for the specific case of professionally producing and maintaining the atmospheres in Thuringian mourning halls (Germany). Funeral services constitute a complex of social practices, which releases affects. Using the example of consultation with the funeral director and the funeral speech, I demonstrate how actors in the funeral services profession engage in the practice and shape the funeral service's atmosphere. Likewise, the present paper outlines that these actors are also affected by the complex of practices and their corporeality as well as disturbances. As a consequence, this disrupts routine performance in funeral service. [ABSTRACT FROM AUTHOR]

Storytelling functions as a means for making sense of and reframing difficulty. The translational storytelling heuristic of communicated narrative sense-making theory proposes that storytelling interventions which facilitate narrative reflection, positive re-framing, and interactional sense-making will positively benefit individuals and families. In this article we describe the process of synthesizing CNSM theory with narrative medicine, narrative theory of identity, and narrative therapy to create a translational storytelling intervention called narrative connection. We then offer a case study using an adaptation of this intervention in the context of parenting. Nine parents in two groups completed the three-week narrative parenting intervention. Preliminary results of the case study suggest that the intervention resulted in an overarching sense of solidarity among parents, facilitates feeling understood, contributes to deeper (self) awareness, and facilitates reassurance, reframing, curiosity, and validation. Overarching benefits included feeling not alone and future plans to be more vulnerable with other parents. [ABSTRACT FROM AUTHOR]

Least restrictive practice is a key principle of mental health legislation. It seeks to minimize coercion and maximize the human rights of mental health service users. Coercive practice, with a focus on seclusion, is explored from a whole-of-mental-health-system perspective as distinct from the behavior of individual service users. Exemplar coercion-reducing strategies arising from the reviewed research and literature are outlined. The exemplars can strengthen the utility of the least restrictive principle by extending non-coercive practice options for mental health social workers. The strategies bring a focus to proactive trauma-informed systemic changes and community level alternatives to hospitalization, coercion and seclusion. [ABSTRACT FROM AUTHOR]

Background: According to Slade's Personal Recovery Framework, mental health recovery involves developing a positive identity, reframing experiences, developing self-management and valued social roles. Aim: This study explored how developing a personal narrative can support mental health recovery through reframing and developing a more positive identity. This paper provides an overview of the study's three phases and the resultant Personal Narrative Workshop Programme. Method: Phase 1 involved developing and analysing my own recovery narrative using autoethnography. Phase 2 used Participatory Action Research (PAR) to explore the experience of other service users, with co-researchers recruited to two focus groups. Six co-researchers continued into Phase 3 (three cycles of PAR) to develop the workshop programme. Results: An eight-session workshop programme was co-produced and fully documented. Conclusions: Developing a narrative is not benign: it can involve reliving trauma; and dealing with the 'voice of others' in our narratives can be difficult. As a result, the workshop programme aimed to provide a supportive environment, promoting collaboration and validation. Methodological issues resulted from the complexities of using a PAR approach, and on the multiplicity of roles for the researcher. [ABSTRACT FROM AUTHOR]

By 2060, almost 25% (98 million) of the population is expected to be aged 65 or older. Health care professionals who provide hospice and palliative care are overtasked and demonstrate symptoms of burnout. Narrative medicine and mindfulness interventions create meaningful connections with patients, improve the delivery of patient-centered care, and enhance the health of the caregivers. In this pilot program, health care professionals in hospice and palliative care settings were invited to participate in a study to evaluate the impact of narrative medicine or mindfulness on measures of burnout and empathy. Participants completed baseline and 12-week post-intervention surveys of burnout and empathy, as well as weekly journals of their experience. Mean overall scores for depersonalization were significantly reduced at 12-week post-intervention. There were no significant changes in emotional exhaustion or empathy compared to baseline. This brief, weekly intervention may be beneficial for both patients and health care professionals in the hospice and palliative care setting. [ABSTRACT FROM AUTHOR]

This work analysed which profiles of counsellors' supportive and interpretative actions emerged in two group counselling interventions designed to promote mentalisation in underachieving university students. The Psychodynamic Intervention Rating Scale was used to analyse this and the level of depth of defence interpretations. Two outcome measures were administered to analyse student mentalisation and their academic achievements. Process findings showed that supportive actions were used for the most part in both counselling interventions; however, only one group improved in terms of mentalisation and academic performance. In the good-outcome group, there were more defence interpretations, especially during the early sessions, and with a deeper level of elaboration. The innovative relevance of these findings and their implications for practice among counsellors are discussed. [ABSTRACT FROM AUTHOR]

The purpose of the proposed activity is to explore topics of identity negotiation and passing while applying the skills of narrative medicine. This activity is part of a larger narrative medicine curriculum designed to help future physicians embrace a narrative approach to reduce social injustices and ultimately to improve their relationships with patients. The activity would be beneficial in health communication courses focusing on patient–provider communication, which address concepts such as illness narratives and empathy. Course: Health Communication (patient–provider communication). Objectives: Students explore topics of identity negotiation and passing in health care using the skills of narrative medicine. [ABSTRACT FROM AUTHOR]

Introduction: A growing emphasis on humanistic medical care has led to the development of programs to imbue more humanistic values into training physicians. The ScribeMD intra-class pen pal program is a narrative medicine tool designed to meet this need with a focus on the journey through medical education. This study intends to evaluate the efficacy of this novel program on the participants' professional identity formation (PIF), emotional intelligence development (EID), and narrative competency improvement (NCI). Methods: This program evaluation involved quantitative and qualitative survey solicitations from first and second-year medical student participants and controls. An efficacy-triangulation model was developed as a quantitative outcome-measuring tool linking objective, writing prompts, and survey data. Results: The quantitative results showed statistically significant improvements in line with the Efficacy Triangulation Model in the participant group. Qualitatively, reflective and insight-driven gains were elicited, as were notable themes of personal and community improvements. Conclusion:ScribeMD poses a unique avenue for the development of more humanistic physicians during their medical education. We recommend additional development of the Efficacy Triangulation Model as well as the program design itself. We also recommend the piloting of this program in other healthcare-education settings both with medical education and other health professions. [ABSTRACT FROM AUTHOR]

Medical professionals in China are increasingly interested and eager to engage in Narrative Medicine. The power of narrative to facilitate medical practices with its competence in the recognition, interpretation, and reconstruction of illness stories is being widely welcomed by physicians to better understand their profession and to cope with the ever-changing work environment. This article examines medical narratives on aspects of the working life in medicine and analyses how physicians' self-reflective writings reshape their outlook upon the ideas of illness, their relationships with others involved in the medical process, and their identity as doctors for the larger community. Contemporary Chinese doctors embrace Narrative Medicine but with variations closely linked to culturally specific customs and concepts. The act of writing about oneself helps to create for medical care providers a context in which science and humanity, past and present, and the individual and his/ her community are all interrelated. [ABSTRACT FROM AUTHOR]

This essay offers a layered account of the origins and enactment of a narrative medicine program at the Ohio University Heritage College of Osteopathic Medicine titled the Open Book Project (OBP). Narrative medicine positions clinical judgment as involving both scientific and narrative reasoning, a set of practices particularly well-suited to fostering inclusive health care and social justice. The OBP involved first-year medical students who met bi-monthly to witness, reflect on, and write about literary passages, visual images, music and lyrics, and other works of art. Sessions also provided opportunities for participants to attentively listen and respond to others, opening themselves to diverse ways of knowing and being. The authors move between academic literature, participants' compositions developed during the project, and students' testimonies to illustrate the dividends and difficulties of narrative medicine. [ABSTRACT FROM AUTHOR]

In this series of experiments, we tested the limits of young infants' word learning and generalization abilities in light of recent findings reporting sophisticated word learning abilities in the first year of life. Ten-month-old infants were trained with two word-object pairs and tested with either the same or different members of the corresponding categories. In Experiment 1, infants showed successful learning of the word-object associations, when trained and tested with a single exemplar from each category. In Experiment 2, infants were presented with multiple within-category items during training but failed to learn the word-object associations. In Experiment 3, infants were presented with a single exemplar from each category during training, and failed to generalize words to a new category exemplar. However, when infants were trained with items from perceptually and conceptually distinct categories in Experiment 4, they showed weak evidence for generalization of words to novel members of the corresponding categories. It is suggested that word learning in the first year begins as the formation of simple associations between words and objects that become enriched as experience with objects, words and categories accumulates across development. [ABSTRACT FROM AUTHOR]

Background: Post-professional residency educational programs aim to advance the knowledge and skills of therapists in a clinical specialty area, however, little is known about the process, outcomes, or effectiveness of residency education. Purpose: The purpose of this study was to use narrative as a teaching and learning tool to gain insight into the progressive development of the residents' learning process. Design: Qualitative methods including a retrospective analysis of residents' narratives were used to explore the professional development and thought process of residents. Methods: Six physical therapy residents wrote reflective narratives across 4 time placements during their one-year residency. Qualitative content analysis was used to analyze the data for types of reflection across time frames and to construct themes based on meaning statements. Results: Four main themes evolved from the residents' clinical narratives: 1) developing clinical reasoning skills; 2) developing professional formation and identity; 3) moral agency; and 4) emerging characteristics of expertise Conclusions: In this study, clinical narratives served as a pedagogical tool to enhance aspects of clinical expertise. The utilization of clinical narrative may be used as one tool to help to create reflective practitioners with improved skills foundational to clinical practice. [ABSTRACT FROM AUTHOR]

This study aimed to determine the efficacy of narrative group therapy in reducing depression and anxiety among children with imprisoned parents. The study design was a randomised clinical trial with an experimental group, and waiting list group as the control group. Eighty-five children with imprisoned parents were selected by convenience sampling method. They were randomly assigned to the experimental and control groups. The experimental group received the narrative group therapy while the control group did not. The research measurement instrument comprised the Children's Depression Inventory (CDI) and the Revised Children's Manifest Anxiety Scale (RCMAS). Analysis of univariate covariance (ANCOVA) and independent t-test was employed to test the study hypothesis. The findings showed that depression and anxiety reduced among children with imprisoned parents with a high effect size (anxiety = 0.90 and depression = 3.05). Thus, the principle and techniques of narrative therapy and the benefits of group therapy reduced depression and anxiety among children with imprisoned parents. Therefore, this study showed that this intervention can be useful for children with imprisoned parents. [ABSTRACT FROM AUTHOR]

Not all physicians readily discuss death with their terminal patients. To explore whether physicians discuss dying with their terminal patients and to pursue an in-depth understanding of patients' perceptions of death, we interviewed terminal cancer patients in a Dutch hospice and compared their stories to quotes from two autobiographies on dying from cancer, Christopher Hitchens' Mortality and Anatole Broyard's Intoxicated by my illness. This narrative medicine study could potentially teach physicians they should discuss impending death to prevent the use of an invasive medical treatment that typically extends the quantity, but not the quality, of life. [ABSTRACT FROM AUTHOR]

Despite significant research on purpose in adolescence and early adulthood, little is known about purpose in older adults. This paper defines purpose as ongoing commitment to and sustained action toward goals that are meaningful to the self and aim to contribute beyond the self. This study of purpose in later life draws on interviews of 102 respondents drawn from a U.S. nationally representative sample of 1198 men and women aged 50–92. Eighteen interviewees are identified as exemplars of purpose beyond the self and are matched with a comparison group of non-purposeful peers. Interview coding revealed that, in contrast to the non-purposeful comparison group, the purpose exemplars describe their lives as including several interconnected sources of well-being: purpose beyond the self, positive relationships, positive life engagement, a sense of competence, and freedom balanced with the desire to contribute. Implications for practitioners and the public are discussed. [ABSTRACT FROM AUTHOR]

Background: This article recognises Professor Linda Worrall's contribution to aphasiology and discusses research themes which have grown from her work. Aims: To review, summarise, and discuss literature relating to four themes which have emerged from the work of Professor Worrall: (1) Research capacity building; (2) Implementation of research evidence in clinical practice; (3) Meaningful outcome measurement; and (4) Improvement of psychological and emotional outcomes. Main contribution: A review of the literature, with examples of practical applications. Conclusions: The work of Professor Worrall has greatly influenced the field of aphasia; her legacy is the research capacity she has built in Australia and around the world. [ABSTRACT FROM AUTHOR]

Aim: Narrative medicine has been promoted as an innovative and effective means of stimulating medical students' professional development by teaching them to approach their patients' experiences of illness with more understanding and compassion. This systematic literature review aims to answer the following question: what evidence of effect is available in the literature about models for teaching narrative medicine? Methods: We conducted a narrative review of 36 articles and used the Best Evidence in Medical Education (BEME) Global Scale and Kirkpatrick Scale for strength and importance of evidence to categorize reported assessment strategies and to evaluate the effectiveness of their narrative medicine programs. Results: We found evidence that narrative medicine is an effective pedagogic tool with a clear and replicable structure and methodology. We also determined that a positive impact could be measured when pertaining to participation and modification of attitudes, knowledge, and skills. However, unequivocal evidence of the effect of narrative medicine on students' behavior or ongoing interaction with colleagues and patients is still lacking. Conclusion: While many recent publications describe the goals and virtues of a narrative-based approach, more research is needed to determine whether or not there is an ideological consensus undergirding this approach. In addition, it is still unclear whether the long-term impact of narrative medicine classroom interventions are felt by patients, or whether such interventions positively impact patient care. [ABSTRACT FROM AUTHOR]

Childhood Sexual Abuse (CSA) is a prevalent social issue. Many theoretical approaches have been applied to the treatment of CSA, these approaches predominately focus on the treatment of children and adolescents, failing to address adulthood and couples' relations. This limited focus fails to address long-lasting relational implications CSA survivors face. This paper proposes the application of a systemic therapeutic modality, Narrative therapy when treating adult survivors of CSA in couple therapy. The treatment of CSA in the context of couple therapy will be discussed. Clinical vignettes will be used. Implications for clinical practice and future research will be discussed. [ABSTRACT FROM AUTHOR]

Background: Post-traumatic stress disorder (PTSD) in paediatric patients following cardiac surgery has been well reported. Patients with Williams syndrome often require surgical intervention to correct congenital cardiovascular abnormalities and typically present with pre-existing interfering symptoms of anxiety. These patients may be at an elevated risk of developing PTSD following surgical interventions, which has yet to be investigated fully. Methods: In this report, we describe the case of a nine-year-old female with Williams syndrome who developed PTSD following extensive cardiovascular surgery. Results and conclusions: This report details the symptoms and outcome of this specific patient with the intent of educating healthcare providers about this possible risk, as well as some potential treatment and prevention options. [ABSTRACT FROM AUTHOR]