Didactic Director Bachelor of Science in Nursing, Unimi, ASST Melegnano e della Martesana
What skills does the health professional need today?

I would summarize the answer by saying: skills to read the complexity of health and illness in the scenario in which we live.

Today people live with health problems that require a systemic approach in order to understand them, much more than was needed in the past; just think of how chronicity represents an increasingly present condition of life and how it practically never affects only one district or apparatus, but multiple dimensions of health and life itself; health issues are closely interrelated, and the main goal of care today should be to help people be able to take care of their own health from the perspective of ensuring well-being, rather than “repairing” a gear that no longer works.

People therefore need professionals who know how to “look at the whole,” caregivers who–in order to succeed in doing so–must be trained and coached to broaden their gaze toward the uniqueness of the other and his or her complexity. Clinical, educational and relational skills need to be developed in order to practice listening and foster understanding of the details and unique ways in which the other experiences his or her health and illness condition. The training of health professionals has always sought to enhance the more clinical skills, that is, more related to the hard aspects of science, while the art portion that is within science was almost ignored.

Instead, we need to give students, professionals and those entering the profession the tools to train them to listen to themselves and to each other. Man has always represented in different art forms the great themes of care, health, illness and suffering. And so art is a fundamental device for working on these sides. After that, an attempt is made to build a narrative curriculum within the educational tracks that goes to work on different themes, to develop different skills.

What is the role of health humanities in the education of the health professional?

What we have been exploring in recent years in the field of health professional education is the need to accompany a humanities education with the development of a professional identity based on caring. The training of health professionals for too long has been a training that is more tied to technical aspects. This is perhaps somewhat more in the field of medicine than in the field of nursing, because in any case nursing has always conceived of health, illness and care as something extremely individual and subjective and therefore requiring a certain approach based on relationships and skills of a relational nature.

Narrative medicine and in any case in general the humanities in my opinion today help students and those approaching a nursing profession to acquire skills that are able to read the complexity of the person that was mentioned earlier. Which then is the real challenge today: to train professionals to read those nuances in the context of health and illness that are not clearly defined. So narrative practices, but humanities in general, are key training devices.

What are your personal experiences of applying health humanities in the professional field?

At the site where I work, we have structured experiential training paths, which accompany the clinical internship of the students; because the real node is not the classroom, that is, the real training context for the care professional is the encounter with the clinic, it is the moment when they meet the patients, they meet the families, and most of the training hours are then in the field. Instead, these have often been the least manned moments from a training perspective. The whole issue of reframing experience that the literature tells us is fundamental to the construction of caregiver identity is something that we often tend to leave in very spontaneous and episodic forms.

So we work on two sides. One is the application of humanities and narrative practices to work on the caregiver. From the very first year of the course, that is, before looking at the other and being able to heal the other, I have to look at what I am experiencing as a healer, what goes on inside me; so we give utmost importance to listening to the self and the consequent self-awareness.

The further we go with training, and thus with experience, the more we use narrative devices to address thematic clusters: for example, the theme of corporeality, death, the theme of difficult communications, pain, suffering, relationships with other professionals. And we work with narrative devices such as autobiographical writings, journaling, visual art, close reading, listening and writing of literary, poetic and musical works, painting, use of plasticine and LEGOs (to represent for example the theme of identity).

You are involved not only in education but also in research. Even today, evidence-based medicine still favors quantitative research over qualitative research, how do we abolish biases about qualitative research and Narrative Medicine in such a quantitative society?

In fact, historically we have seen a kind of bias that has certainly led to placing a great deal of value precisely on the quantitative component: for example, systematic reviews, meta-analyses, randomized clinical trials and so on. Journal rankings, h-indexes, impact factors are all bibliometric parameters that are created by having that kind of hard research as a reference, which is quantitative research. And so it goes without saying that so-called qualitative research was kind of relegated to the case study level, as if methodologically it was less relevant and rigorous. And so in short the bias stems from that, after that I think there are some phenomena that of course have to be approached numerically and statistically, but there are so many phenomena concerning care that cannot be approached numerically.

For example, in the Covid period we had evidence of this. A lot of scientific production in that period went in the direction of the sense of understanding what the experience of caregivers was, what patients were experiencing, what family members were experiencing. These are examples that lead us to say that qualitative research gives us a range of information about phenomena that cannot be approached any other way. The experience of pain, emotional experience, people’s perceptions, are other examples of aspects that require a qualitative look, which aims to understand the human experience as a whole.

The humanities require a qualitative approach, but it takes a certain expertise because using words, handling words and not making words say what we want them to say, but returning the correct meaning, is a very delicate job.

So in my opinion in recent years we have realized that we sometimes need to produce quality rather than quantity, that is, there is a bit of a rediscovery of what was improperly called “humanization of care,” there is also today a strong return to the demand to make sense of research as well. Bringing numbers closer to words, in short.

Today we have so many narrative tools available, there are data collection tools to then produce qualitative research; because, for example, if I collect good stories of care, narratives of experiential experiences of patients in certain contexts and in certain situations, this is material that helps us a lot then to do qualitative analyses. In my experience I can say that narrative medicine is the look I have when I do qualitative research, and some narrative devices are very useful data collection tools for the purpose of qualitative research.

We then have the need today to give evidence anyway of the impact that narrative practices have on care with measurable outcomes; and we are also working on that in my opinion, we are beginning in short to see interesting productions in that sense.

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