Susanna Ponti and Michela Zanandrea are nurses, lecturers and coordinators respectively of the second and third year of the Degree Course in Nursing at the University of Ferrara. For years they have been involved in training, and alongside their academic role they are facilitators in the Narrative Medicine workshops promoted by SIMeN – the Italian Society of Narrative Medicine.
Their commitment moves in the wake of a nursing practice that recognises the centrality of narrative as clinical, formative and reflective practice: a view that values lived experience, both of the patient and the professional, subjectivity, and the relationship as a place of care. It is in this direction that their work on narrative nursing, inside and outside the hospital context, also develops.
- Susanna, Michela, how did your encounter with Narrative Medicine (MN) come about? Were there episodes, readings or encounters that ignited in you the intuition that this approach could deeply enrich the nursing profession?
Susanna: Personally, in 2017, after finishing the Postgraduate Course in Bioethics at the University of Padua, I felt the need to deepen methodologies that would allow me to understand and accommodate the instances of patients and their families faced with complex choices regarding their care pathways. I knew that their experience was fundamental to make a relevant and ethically appropriate analysis, but my way of dealing with clinical situations was guided, and perhaps conditioned, by evidence-based nursing and this limited my ability to listen deeply to what they were telling me. I had already read a number of Giorgio Bert’s publications and had been fascinated by his reflections, the illness narrative was a central subject for the caregiver in order to truly put the sick person at the centre of any clinical-assistance action. So I decided to enrol in the Master’s Course in Applied Narrative Medicine at ISTUD and it was a substantial choice: I got to know the world of Narrative Medicine, with its theory, methods and tools; I experienced a ‘humanistic’ way of building the care relationship. I thus found confirmation of a personal feeling, which had accompanied me throughout my professional life, namely that no caring action can disregard a trusting relationship with the patient, in order to be appropriate and personalised at the same time. The relationship is the place where care is realised.
Michela: I started this journey with Narrative Medicine thanks to the thousands of questions and doubts I was asking Susanna day after day during her attendance at the ISTUD master’s course. It was a real example of positive, virtuous contamination. I was deeply impressed by the authentic power of words, the real ones, listened to directly by patients: words capable of going beyond the signs of the disease, painfully imprinted on their bodies, and able almost to free them, making them aware of their past and present, and ready to imagine a future. I come from several years of working as a nurse in intensive care settings, where the sounds of alarms take the place of speech and the caring relationship, by necessity, passes through the use of technology. Precisely because of this, I felt the urgency to return to recognising the uniqueness of the person and to stop and reflect, thanks to Narrative Medicine, on the profound meaning of Care. Readings and reflections by Luigina Mortari then helped me to grasp its true essence: ‘Care is not a feeling or an idea but an act, because it is something you do in the world in relationship with others’. Then I realised that the time had come to cultivate, in the health professions, right and just thoughts, capable of doing good not only to patients, but also to the professionals themselves, giving meaning to their stories.
- Indeed, the narrative approach seems to give back space to the patient’s subjective experience and the practitioner’s experience. What, in your opinion, is the added value that this view can offer contemporary nursing, both in education and in the quality of care and the nursing relationship?
S&M: Relational competencies for the nurse practitioner are crucial for ensuring effectiveness, appropriateness and personalisation of the care provided. In basic and advanced nursing education we find the theoretical contents with respect to these competences but, in fact, there is a lack of opportunities to experience them in practice in a meaningful way. In fact, in clinical training the learning of technical skills prevails, which are necessary and fundamental to guarantee safety in practice, but not exhaustive to determine a learning that transforms the future professional into a caregiver. He, that is, who cares about making the life in front of him flourish again, thus realising the highest form of care, which translates well with the Greek concept of epimèleia. In this sense, the narrative approach requires one to sharpen skills of listening and deep understanding towards the other, but also towards oneself. It accompanies a real and contextual understanding of the illness experience, guaranteeing personalisation of care, as it is shared and constructed with the person. Moreover, it also allows the professional to reflect on himself and his own experiences, thus acquiring keys that stimulate awareness and management of the positive or negative emotions that emerge from care relationships and that if not processed can be a heavy and painful burden for the professional. This is why it is important that these tools, this narrative posture, are also introduced at an early stage of training. At first, students may feel intimidated by this way of entering and being in the caring relationship. However, through practice, they recognise its value and potential and are often deeply impressed and enthusiastic about it. In fact, they learn to get in touch with and handle their emotionality in a more conscious way, and they are able to start building a protective – and not defensive – shield that is fundamental to safeguarding their integrity, both personal and professional.
- Within the Ferrara University Hospital, you carry out structured work on these issues. Can you tell us about it? What are the most significant lines of development that you have built up in recent years and with what objectives?
S&M: We imagined to outline three paths: to implement relational competences through the methodology of Narrative Medicine for future professionals; to promote the transformation of caring relationships through the acquisition of the narrative posture in nurses; to disseminate and spread the knowledge of Narrative Medicine among health professionals.
Stimulating the curiosity of health professionals towards Narrative Medicine was our starting point. The first objective was, in fact, to promote interest in the possibility of being in care relationships with attitudes and behaviour that are not only ‘scientific’ but also ‘humanised’, thus dispelling the prejudice – often unspoken – that listening too much to people risks falling into an inappropriate and sometimes energy-consuming storytelling, perhaps even risking one’s professional authority for some. Active listening, sharing, reflection on the experiences narrated and on one’s own, were the methodologies we wished to make known and appreciated, in order to build new care paths with our patients. At the same time, for university training, within the three-year nursing course, the Course Council had evaluated the opportunity to include teaching modules that would implement learning of relational skills and consequently we proposed to build a course in Narrative Medicine. To date, 4 years after the activation of the course (by choice), we can say that it was a positive decision: about 70% of those enrolled in the second year choose to attend this teaching and in the third year at least 4 or 5 dissertations deal with topics or propose care planning, on specific clinical cases, using the narrative approach. In addition, over the years, we have taken several opportunities to participate in conferences which, although not dealing specifically with Narrative Medicine, offered us the opportunity to show the potential of the latter as a clinical-assistance methodology. For example, as part of the initiatives dedicated to women’s health, our company organised a conference on prevention and women’s health, and on this occasion we tackled the perception of pain by reading the stories of women suffering from endometriosis, where physical suffering is continually mixed with the frustration of being denied and not recognised in their illness, often also discriminated against by gender prejudices. Recently, in September 2024, we also took part, with a creative writing workshop, in another event promoted by the AUSL of Ferrara, entitled ‘Words that cure: poetic language between care, culture and prevention’, which involved not only health professionals but also school teachers and educational staff, thus representing a new and stimulating experience, capable of creating unprecedented connections between different worlds, united by the common intention of taking care, including through words.
- In 2022 you promoted the project ‘Narrative Medicine – Stories that unite, stories that heal’. What exactly was it about, who was it aimed at and what do you think were the most significant outcomes, both in the short and long term?
S&M: This short 4-hour course, conducted in synchronous mode, was open to all the health professions in our company and was the launch that, like a pebble in the water, spread waves of interest and desire to learn more about this way of approaching relationships and integrating care. On this occasion, thanks to the expertise of the speakers Maria Giulia Marini and Paola Chesi of ISTUD Sanità e Salute and Stefania Polvani of SIMeN, interest, curiosity and, above all, the desire to experiment with the methodology spread. Subsequently, an initial 18-hour blended course was designed for a specific group of professionals (family and community nurses) to respond to their need to improve tailor-made care relationships with the chronically ill patient at home, in order to ensure compliance and empowerment. The parallel folder was the tool used by each professional and subsequently shared among the participants to reflect and build new ways of taking care of their patients. Subsequently, a second course, again of 18 hours in presence, constructed as an experiential workshop, involved the same group of professionals and also included a group of second-year students who had attended the NM course. The aim was to support carers in processing – by means of playful and creative tools – their experiences with regard to everyday care stories, in order to promote the development of an emotional intelligence that would help them to cope with and support emotions and discomforts arising from the professional experience. The interaction between experienced nurses and newcomers in training was also particularly interesting: the experience of the former and the genuineness of the latter created a dynamic, creative and constructive context that generated a whirlwind of positive energy for the wellbeing of each.
- Is an update or continuation of these paths planned? What perspectives are opening up within the company today to strengthen the narrative approach in nursing care?
S&M: To date, two more experiential workshops, requested by the management, are being planned for other groups of professionals from other clinical care areas. One will be dedicated to the nursing team involved in organ and tissue harvesting, and the other to multidisciplinary teams working in the oncology department, with the aim of disseminating the narrative approach, on the one hand to support operators and their well-being thanks to reflective practices, and on the other to improve the development of authentic therapeutic relationships between caregivers and patients, on the basis of which care pathways can be co-constructed. We will promote reflexive learning about communication modalities with the aim of transforming therapeutic communication into gentle communication, that which starts from the patient’s or caregiver’s questions, which accompanies them to the understanding of what is happening and contextually supports them moment by moment (in the here and now) in the care pathway, by virtue of the needs that the narration of their experiences brings out. In fact, these are not always the same needs as those envisaged in the care protocols and the therapeutic responses do not always correspond to the person’s priorities.
- Narrative posture, active listening, time for reflection: can this approach really be maintained in a hospital context often marked by urgency and organisational pressure? What are the main obstacles – but also the opportunities – you encounter in this respect?
S&M: The use of experiential training has an “engaging” effect on participants, who experience the effectiveness of the method for themselves, and are so fascinated by it that they continue strenuously, even in critical organisational situations, to use what they have experienced: collecting a testimony from the patient or caregiver, writing down their own story with respect to a care attendance, sharing their thoughts and actions in the group.
- In conclusion, why do you think it is worth continuing to believe in the transformative power of narrative nursing within healthcare organisations? What kind of impact can it have, not only on the quality of care for patients, but also on the well-being and motivation of professionals?
S&M: We firmly believe that kindness, mutual understanding, closeness, sharing and gratitude can be a driving force for all care professionals to face the daily and future challenges arising from a complex and increasingly technological healthcare system, which risks undermining the recognition of the human being, limiting the allocentric position that is proper to the care professions.