After the Master in Applied Narrative Medicine: Susanna Ponti’s experience

SUSANNA PONTI is a didactic tutor for the degree course in Nursing at the University Hospital of Ferrara and participated in the Master in Applied Narrative Medicine of Fondazione ISTUD a few years ago.

How did the decision to train in medical humanities and narrative medicine come about and with what expectations?

Listening and reading stories is a passion that has accompanied me since I was a child, writing “my side of the story”, something that has always made it easier for me to understand what was happening around me. When I decided to take up the nursing profession, what attracted me most was the possibility of meeting and helping people, dedicating my time and energy to understanding what they needed; I was more frightened by the need to perform technical and often invasive acts on their bodies, than by the need to welcome their fear and suffering every day; but I was very wrong. My professional growth, after my academic training, was guided by almost twenty years in a rehabilitation unit specialising in the care of patients with severe acquired brain damage. The world of severe disability is a world with very complex internal dynamics, both with regard to patients and their families, and to the fact that it obliges each healthcare worker to use collaboration, cooperation and professional recognition as standards of behaviour to strive for, in order to guarantee appropriate care. It was there that I learnt, and shared with other colleagues, that it is necessary to wear ‘special lenses’ in order to observe, understand and accompany patients and their families towards a new life, different from the one planned and until recently lived, but still a worthy life, with its load of suffering and frustrations but also of joys, victories and regained autonomy. The experience and continuous training in the field have allowed me to acquire tools to improve communication, active listening, the ability to understand and manage emotions, but this happened in itinere, sometimes compromising the effectiveness of the assistance provided, occasionally making difficult interprofessional relationships, exposing me to the risk of burn out and often leading to personal emotional distress of which I became aware only much later. This justified the search for training courses, functional to the acquisition of relational skills, which would improve me as a professional, and which could help me to accept and manage the burden of pain with which I was confronted every day. Hence the fortunate decision to enrol in ISTUD’s Master in Applied Narrative Medicine, where we have, on several occasions, applied methods and tools of narrative medicine to the acquisition of knowledge on the subject in an atmosphere of continuous comparison and experimentation of those relational skills that are fundamental for all the helping professions.

What do humanities and narrative medicine represent today in your work of training future nurses?

The nurse of the third millennium is required to have a high level of scientific knowledge in order to respond safely and appropriately to the health needs of increasingly complex patients, especially those suffering from chronic and chronic degenerative diseases. In addition, technical and specialist skills are required to support the performance of complex care practices that often involve the use of high-tech equipment. Moreover, since healthcare organisations are complex professional adhocracies, il is essential that he/she be able to apply himself/herself to formal and extra-professional tasks: the fragmentation of processes subtracts value from the global vision of the person assisted, considerably limiting the personalisation of care. In fact, this is in contrast with the regulatory mandate of the recent Law 219 of 2017 and does not respond much to the socio-cultural climate in which the nurse, today, manifests his professionalism and daily acts according to his competence, as expressed in the code of ethics of 2019. We, as educators, are therefore obliged to keep the “straight edge”, with the aim of guaranteeing the technical-scientific and disciplinary preparation of future professionals at high levels, without however neglecting the development of that emotional intelligence that will make them complete and mature nurses. The humanities are disciplines that help to develop a critical sense and reflective capacity, help to implement observation skills and interpretation of facts contributing to improve relational skills. The vision of narrative medicine and the centrality of the person taken care of, pushes the future professional to continuously ask himself questions about the quality and therapeutic value of the relationships he builds with the patient. Finally I would also like to say that, as a trainer, I feel an obligation to stimulate the development of emotional intelligence on the part of the future nurse, because it will guide him/her to never take oneself for granted, to not reify those he/she cares for, thus drawing positive energy to lead a rewarding and stimulating professional life.

Can you tell an example of the application of humanities and storytelling in your reality?

As a teacher, I am deeply convinced of the importance of using the languages and tools of the humanities in training; very frequently I include readings of passages or the viewing of film sequences that deal with issues relating to disability, chronic illness, illness with an unfavourable prognosis or in its terminal phase in my classroom lessons. Through filmography I am able to address some ethical content of care and stimulate discussion on how to build care relationships in such emotionally and clinically complex situations. Often, the vision triggers reflection on communication styles, on the use of non-verbal communication and on the importance of listening to the other person, and the students’ participation is lively, interested and very fruitful.

The use of narration is a little more complex. There is still resistance on several levels to recognise its validity in nursing education, especially in basic education, where the acquisition of technical and disciplinary competences is central to the learning of so-called soft skills.

I have personally experimented with its use in order to address some critical organisational issues in the conduct of students’ clinical placements. Due to the pandemic emergency, it was necessary to change the way clinical training was carried out, suspending the tutoring activities in close proximity (i.e. a tutor a student always together throughout the training). This change was welcomed by students with many perplexities, related to the lack of a continuous tutor figure during clinical practice. They stated that they feared that being daily side by side with different professionals, and often not trained to carry out tutoring functions, would limit their clinical learning and, above all, that an educational relationship, useful for their professional growth, would not develop. So I proposed a reflective writing exercise, to be carried out during the practical traineeship, through the writing of a story/fairy tale following a format, pre-constructed according to the general scheme of Propp’s fairy tale. Participation in the project was voluntary, but a high percentage participated with curiosity. By analysing the characters in the magic triangle of the fairy tale, it was possible to understand their experiences and it emerged that, after an initial moment of discouragement and disorientation, they were nevertheless able to attribute meanings and acquire skills from this “different from the others” experience. The lack of a tutor figure has, so to speak, “made them more attentive” to the operational and relational deficiencies in the work of the entire nursing team, an almost painful, destabilising observation. At the same time they touched with their own hands the emotional and working load of all the professionals and observed their adaptation strategies, appreciating the value of communication, empathy, listening and sharing. And this seems to me to be a great educational outcome.

Still as a didactic tutor, I also experimented the use of the parallel folder, to facilitate the development, through reflection on the experience, of procedural skills such as diagnostic reasoning, prognostic judgement and decision making. Students were asked to write the Parallel Folder for a patient (clinical case) assisted in the training and chosen by themselves, due to personal interest, complexity or emotional involvement. What emerged strongly was that the students, by writing the parallel file, became aware of the time they dedicated to listening to the patient, and above all how much this active, intense and involved listening facilitates the therapeutic relationship, with the result of improving coping and empowerment. All the students declared themselves very satisfied with the experience because it helped them to become aware of their own emotions, of how the patient lives the state of illness and how much this affects his daily life and relationships. Most of them also affirmed that “writing down what happens to the patient and how he/she behaves as a consequence”, helps them to see better the outcomes of the care provided, and often this allows them to feel gratifying feelings, of confirmation of their professionalism. Also in this case I can affirm that reflexivity in training is a competence to be stimulated as much as technical competence, because to reflect habitually on one’s own work offers the opportunity to choose critically which behaviours to repeat, which to abandon, which to improve in order to promote personalisation and humanisation of care.

What is your next project related to narrative medicine?

I have a project which, because of the pandemic, has remained in the drawer but I hope to be able to realise it in the next academic year. It will involve an RSA in the municipality of Ferrara, the site of clinical training, and a group of nursing students. As a trainer, I consider the geriatric-residential setting to be a highly formative environment, since it offers the opportunity to learn and experiment in the field the assistance in chronic conditions, in all its specificity and complexity, and also for the opportunity to understand the network of territorial services dedicated to chronic conditions, today more than ever a health problem of great importance.

It is a theatre workshop, “The Theatre of Memory”, whose aim is tertiary prevention and rehabilitation of relational skills of elderly people with dementia. The objectives we would like to achieve are essentially to improve the quality of life and time lived, restore motivation and self-esteem, stimulate attention and recover residual mnestic skills and capacities of RSA guests. People with dementia find it difficult to recall and discuss current events, but they find it easier to talk about past events in their lives, and the act of recovering past memories becomes a source of psychophysical well-being. It is a safe space to protect oneself from feelings of inadequacy, loss of self, difficulties in daily activities, inability to interact with others and frustration at not being able to converse comfortably – often due to difficulty in storing new information or in recalling recent events.

The narrative approach is useful in the management of dementia because it allows us to relate to patients through a privileged channel, which is precisely that of the narration of their life stories. What is told is the story as it is felt and still lived by the person telling it, as it still resonates within the person telling it.

Exploration into “memory” and the techniques of “narrating” will guide the first stages of the workshop’s work, giving rise to a theatrical event which, by composing the areas of subjective memory into a common tale, proposes the reading of a piece of life history through the metaphors of micro-stories. Childhood games, youth dances, the experience of war, festivals and popular traditions, the world of work, the elderly in the family and in contemporary society will be the topics of the first phase of the workshop. The work may continue in the direction of a confrontation between generations: the grandparents (guests of the facility) become the protagonists of a tale addressed to their grandchildren (nursing students). All this will end with “The Show”, a small performance of the stories told by the patients, collected and transcribed by the students, and recited, or rather, told together. But this is also a story, and what’s more, it hasn’t happened yet… we will see what the ending will be.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.