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At least 37 records · Page 2Linked to original sources

PubMed2001

Analysis of narrative ability in children with cochlear implants.

PURPOSE: The purposes of this study were to: 1) develop a scoring system to assess narrative ability in children; 2) evaluate the impact of auditory speech perception with a cochlear implant on narrative ability; and 3) evaluate the importance of narrative ability to reading comprehension in deaf children. DESIGN: Narrative productions prompted from an eight-picture sequence story were elicited from 8 and 9 yr olds; 87 who had at least 4 yr of cochlear implant experience and 28 who had normal hearing. The stories were transcribed and a scoring system for narrative ability was developed based on the use of complete narrative structure, conjunctions linking semantic relations, and referents that served to identify and distinguish characters in the narrative. Narrative ability scores of cochlear implant users were examined in relation to their age, IQ, speech perception, language, and reading test scores. In addition, narrative ability scores for children with normal hearing were compared with two groups of cochlear implant users, those with above average speech perception scores and those with below average speech perception scores. RESULTS: Within the sample of hearing-impaired children, narrative ability scores correlated significantly with speech perception, language syntax, and reading test scores. A multiple regression analysis was conducted to predict reading comprehension scores from four predictor variables (age, IQ, language syntax, and narrative ability). Results reflected the independent contribution of discourse-level language skills, as measured by the narrative ability score, as well as sentence-level language skills in predicting reading test scores. Analysis of stories obtained from 8- and 9-yr-old children with normal hearing revealed the classic pattern that included a high point, a resolution, and one or more evaluative statements. Their stories achieved cohesion from correct use of both conjunctions and referents. Deaf children who received above-average speech perception scores with a cochlear implant (i.e., scored above 48% on the Word Intelligibility by Picture Identification speech perception test) told narratives that were similar in structure and use of referents to those of age mates with normal hearing. Although their use of subordinate conjunctions was not as well developed as normal-hearing children, it was significantly above that of deaf children who received less speech perception benefit after a similar period of implant use. These below-average speech perceivers exhibited significantly poorer use of narrative structure and cohesive devices than either normal-hearing age mates or children who achieved above average speech perception with a cochlear implant. CONCLUSIONS: Narrative ability is an important predictor of reading comprehension ability in deaf children above and beyond IQ and syntactic competence. Children who receive a cochlear implant under 5 yr of age and obtain above average speech perception benefit from the device construct narratives that are similar in structure and cohesion to those of their hearing age mates by age 8 to 9.

Adolescent↗

PubMedDate not supplied

Narrative, ethics and people with severe mental illness.

Starting from the premise that people are essentially narrative beings, I argue that the onset of severe mental illness compromises the narrative enterprise of being able to construct one's Self and one's relationships in meaningful and coherent ways. This is due to both the curtailment of opportunities for narrative engagement and the dispossession of those whose narratives do not conform to the current conceptualization of narrative and narrativity. In these circumstances, supporting the narrative enterprise is an ethical endeavour that requires that we examine not only which narratives we construct, but also how we construct them. This requires a re-thinking of what might constitute narrative and how we might facilitate or enhance the narrativity of people with severe mental illness. Following this, I suggest four means to support the narrativity of people with severe mental illness: through maintaining narrative continuity, maintaining narrative agency, countering master narratives and attention to small stories.

Attention↗

PubMed2006

Who speaks? Who looks? Who feels? Point of view in autobiographical narratives.

In this paper, the author aims to substantiate Freud's claim that neurotic illness creates gaps in autobiographical narratives in terms of the narrator's stating and inducing perspectives. He sketches out the role of narrative perspective and the joint taking of a shared perspective by analyst and patient in psychoanalytic therapy. He introduces four ways of representing perspectives in narratives. Three degrees of narrative distortion are exemplified by three excerpts from life narratives and explored in terms of narrative perspective representation. The most comprehensive perspective representation is achieved in the first example by explicitly stating the present perspective of the narrator as well as the past perspective of the story's protagonist by use of mental verbs. In the second narrative, exclusive use of linguistic forms for inducing the protagonist's perspective both overwhelms the narrator and gives the listener an incomplete picture of what happened. Inconsistent motives, denial of responsibility and omission of detail render the third narrative even more difficult to follow. The author discusses the clinical significance of this exploratory analysis of perspectives in narratives in terms of claiming responsibility for one's past action and of level of defence mechanisms, and by highlighting the emotional impact on listeners, which the author suggests is the stronger the more perspectives are left out. He discusses analogies to countertransference. The analysis of narrative perspectives offers an approach for systematic research in psychoanalytic practice.

Adult↗

PubMed1997

Disclosure practices and cultural narratives: understanding concealment and silence around cancer in Tuscany, Italy.

Disclosure practices are embedded in and enact personal, professional, and societal narratives. These narratives are not given but contested and evolving. The medical arena constitutes an important social space in which this contestation, reproduction and change take place. More specifically, based on ethnographic and cultural survey data, we describe and interpret the cultural sense of "not telling" about cancer within the local world of Tuscany, Italy. We locate the traditional practice of non-disclosure of cancer diagnoses within a larger cultural narrative we call "social-embeddeness", a narrative of social unity and hierarchy, of protection from or adaptation to the inevitable necessities of life, in part by using narrative itself to construct a sense of group protection. This narrative is being challenged, as it confronts other medical and societal narratives, such as one originating from the United States and embedded in health care practices like open disclosure, informed consent, Advanced Directives, and the Patient Self-Determination Act, what we call the "autonomy-control narrative". Explicit disclosure to a patient about his or her illness and the future plays an important role in actualizing this narrative, in helping in the quest to control one's destiny, eliminate uncertainty and necessity, and foster a person's identity as singular and sovereign over him/herself. The concept "narrative" highlights the ideology and intent of people's practices, not just "outcome", and helps us understand contradictions in various disclosure contexts as partly due to multiple cultural narratives in play. Considering some of the practices and understandings embedded within and reproduced by the larger cultural narratives also allows us to track the dynamics of history and individual biography, to locate and compare approaches to disclosure across time and space, and to avoid the pitfalls of cultural determinism and cultural stereotypes.

Bioethics↗

PubMed2000

Illness narratives: time, hope and HIV.

Life threatening illness, such as HIV/AIDS, also threaten people's sense of identity and taken-for-granted assumptions about the temporal framing of their lives. In response, people often experience transformations in values, spirituality and life priorities. Drawing on a combined quantitative and qualitative study of people living with HIV/AIDS in Australia, three different narratives that people use to make sense of their illness experience are identified: linear restitution narratives, linear chaotic narratives and polyphonic narratives. Linear illness narratives colonise the future, assuming that the future can be controlled through human action. They emphasise a faith in medical science, tend to be secular and self-centred and assume the end of life to be in the distant future. Hope is focused on concrete outcomes such as improved health or material possessions. Linear narratives can be either restitutive or chaotic. Restitutive linear narratives anticipate a life that will mirror the narrative. Chaotic linear narratives anticipate a life that will fail to meet the linear ideal resulting in despair and depression. In contrast, polyphonic illness narratives are oriented toward the present, emphasising the unpredictability of the future. These narratives tend to include spiritual experiences, a communally oriented value system, and to recount increased self-understanding and the gaining of new insights as a consequence of their illness. Hope in polyphonic narratives is more abstract and focused on a celebration of mystery, surprise and creativity.

HIV Infections↗

PubMed1997

Developing narrative structure in parent-child reminiscing across the preschool years.

This study is a longitudinal exploration of relations between parents' and children's provision of narrative structure in joint retellings of the past and children's developing personal narrative skills. Fifteen White, middle-class families participated when children were 40 and 70 months old. At both ages, mothers and fathers talked separately with children about shared past events and uniformed experimenters elicited children's personal narratives. Whereas mothers and fathers did not differ in how they structured past narratives, children narrated differently with fathers than with mothers. Further, even at 40 months, girls' narratives were more contexted and evaluative than boys, but parents' provision of narrative structure increased similarly with daughters and sons over time. Children's early abilities to provide evaluative narratives was a strong predictor of their later abilities to provide evaluative narratives; maternal emphasis on evaluations also predicted children's later narrative structure. Parental and child influences on personal narrative skill development are discussed.

Affect↗

PubMed2003

Genre and evaluation in narrative development.

In this study I examine Venezuelan children's developing abilities to use evaluative language in fictional and personal narratives. The questions addressed are: (1) How does the use of evaluative language vary in fictional and personal narratives? (2) Is there a relationship between the use of evaluative language in these two narrative genres and children's age and socio-economic status (SES)? The sample consists of 444 narratives produced by 113 Venezuelan school-age children participating in 4 narrative tasks, in which personal and fictional stories were elicited. Findings suggest that age and socio-economic status have a greater impact on the use of evaluation in fictional stories than in personal narratives. Low SES and younger children are at a greater disadvantage when performing fictional narratives than when performing personal narratives. These results strongly imply that children's narrative competence cannot be assessed in a single story-telling task, given the importance that task-related factors seem to have on narrative abilities.

Child↗

PubMed2005

Narrative methods in quality improvement research.

This paper reviews and critiques the different approaches to the use of narrative in quality improvement research. The defining characteristics of narrative are chronology (unfolding over time); emplotment (the literary juxtaposing of actions and events in an implicitly causal sequence); trouble (that is, harm or the risk of harm); and embeddedness (the personal story nests within a particular social, historical and organisational context). Stories are about purposeful action unfolding in the face of trouble and, as such, have much to offer quality improvement researchers. But the quality improvement report (a story about efforts to implement change), which is common, must be distinguished carefully from narrative based quality improvement research (focused systematic enquiry that uses narrative methods to generate new knowledge), which is currently none. We distinguish four approaches to the use of narrative in quality improvement research--narrative interview; naturalistic story gathering; organisational case study; and collective sense-making--and offer a rationale, describe how data can be collected and analysed, and discuss the strengths and limitations of each using examples from the quality improvement literature. Narrative research raises epistemological questions about the nature of narrative truth (characterised by sense-making and emotional impact rather than scientific objectivity), which has implications for how rigour should be defined (and how it might be achieved) in this type of research. We offer some provisional guidance for distinguishing high quality narrative research in a quality improvement setting from other forms of narrative account such as report, anecdote, and journalism.

Health Services Research↗

PubMed2004

Traits and stories: links between dispositional and narrative features of personality.

Dispositional traits and life narratives represent two different levels of personality that have not previously been empirically linked. The current study tested five hypotheses connecting Big-Five traits to life-narrative indices of emotional tone, theme, and structure. Students (Study 1) and adults (Study 2) completed a self-report measure of the Big-Five traits and provided extended written accounts of either ten (students) or eight (adults) key life-narrative scenes, including life high points, low points, and turning points. Content analysis of the narrative data revealed that for both samples Neuroticism was positively associated with an emotionally negative life-narrative tone, Agreeableness was correlated with narrative themes of communion (e.g., friendship, caring for others), and Openness was strongly associated with the structural complexity of life narrative accounts. Contrary to prediction, however, Conscientiousness was not consistently associated with themes of agency (e.g., achievement, self-mastery) and Extraversion was unrelated to positive narrative tone. The results are discussed in the context of contemporary research and theorizing on the narrative study of lives and the relation of narrative research in personality to more conventional, trait-based approaches.

Adolescent↗

PubMed2003

Narrative research: a review of methodology and relevance to clinical practice.

Using qualitative narrative research to explore how people proceed through cancer diagnosis and treatment may help clinicians render better care and consequently enhance the probability of optimal health outcomes. Narrative research can be defined as collecting and analyzing the accounts people tell to describe experiences and offer interpretation. Often, oncology clinicians use narrative methods to investigate issues such as clinical outcomes, coping, and quality of life. Narrative research provides an option to explore personal experiences beyond the boundaries of a questionnaire, providing insight into decisions involving treatment, screening or various health practices, which can help guide how health care services are developed and provided. The purpose of this article is to illustrate the use of narrative research methods to a clinical audience who may not be as familiar with narrative technique. Definitions of narrative research, examples of published research using narrative methods in healthcare, validity and data analysis will be addressed. A review of current literature from sociology, anthropology, nursing and psychology demonstrates that narrative methods are an effective research option that can lead to enhanced patient care.

Health Policy↗

PubMed2006

Analysis of narratives produced by four children who use augmentative and alternative communication.

UNLABELLED: The ability to narrate a story is fundamental to the development of overall communicative competence and involves the coordination of a variety of knowledge structures and linguistic abilities. In this study, the narrative discourse abilities of four children who use AAC are described in the context of five tasks designed to elicit a spectrum of narrative skills. Assessment was achieved through application of the Narrative Assessment Profile tool [Bliss, L. S., McCabe, A., & Miranda A. E. (1998). Narrative assessment profile: Discourse analysis for school-age children. Journal of Communication Disorders, 31, 347-362.] and analysis of seven major story elements. Our results indicate that most narrative discourse dimensions in our participating children appeared to be compromised and in need of intervention. Discussion includes aspects of narrative intervention and suggested topics for further research. LEARNING OUTCOMES: The reader will be able to: (1) create a list of issues involved in the development of narrative abilities of children who depend on augmentative and alternative communication systems (AAC) and (2) describe the issues involved in assessing the narrative skills of children who use AAC.

Arthrogryposis↗

PubMed2003

Using SNAP Dragons to monitor narrative abilities in young deaf children following cochlear implantation.

OBJECTIVE: To assess the narrative abilities of young deaf children before cochlear implantation and 1 and 2 years following implantation, and to explore possible changes in the implanted children's preferred mode of communication in the narrative abilities task. STUDY DESIGN: Prospective longitudinal study assessing the narrative abilities of young deaf children before and after cochlear implantation. SETTING: Pediatric tertiary referral center for cochlear implantation. PATIENTS AND METHODS: The narrative abilities of 35 young profoundly deaf children were assessed before implantation and 1 and 2 years following implantation using the Stories/Narratives Assessment Procedure. Children with age at implantation less than 6 years were included in the study (mean age at implantation was 3.5 years; range 1.4-5.9 years). All children were filled with the Nucleus multichannel cochlear implant system. With respect to their communication modes, they came from a wide range of backgrounds and all children were encouraged to use their preferred mode of communication during the narrative task. RESULTS: The data showed that there was a statistically significant increase in narrative abilities across the three data points (P<0.001). Before receiving the implant, children were mostly in the pre-structural, receptive stages and could at most label or comment on the pictures (median narrative stage 2). By the 2-year interval, children were mostly using one or two categories or one complete episode with spontaneous retelling (median narrative stage 4). Although children were not pressured to use any particular communication mode, a shift to speech was found following implantation and this was statistically significant (P<0.001). CONCLUSION: Young implanted deaf children showed a significant progress in their narrative abilities through time and a significant shift in the predominant mode of communication towards more speech orientated communication modes following cochlear implantation.

Books↗

PubMed2006

Child, parent, and parent-child emotion narratives: implications for developmental psychopathology.

Studies using narratives with children and parents offer ways to study affective meaning-making processes that are central in many theories of developmental psychopathology. This paper reviews theory regarding affective meaning making, and argues that narratives are particularly suited to examine such processes. The review of narrative studies and methods is organized into three sections according to the focus on child, parent, and parent-child narratives. Within each focus three levels of analysis are considered: (a) narrative organization and coherence, (b) narrative content, and (c) the behavior/interactions of the narrator(s). The implications of this research for developmental psychopathology and clinical work are discussed with an emphasis on parent-child jointly constructed narratives as the meeting point of individual child and parent narratives.

Affect↗

PubMed2003

Gadow's relational narrative: an elaboration.

Nurse philosopher Sally Gadow (1999) has proposed the relational narrative between patient and nurse as a 'postmodern turn' for nursing ethics. She has conceptualized this moral approach as the construction by patient and nurse of a coauthored narrative describing the good they are seeking, as well as the means to achieve this good. The purpose of this article is to provide an elaboration of Gadow's seminal conceptualization of relational narrative based on her writings and those of other philosophers. The article will further develop relational narrative's foundations in relationship and narrative and will explore engagement as a dimension essential to its creation and growth. The elaboration first builds on the notion of relationship as foundational to this postmodern moral perspective. Narrative then is advanced as being at the heart of the patient-nurse relationship and their relational narrative, based on an exploration of narrative's role in the moral realm as an epistemology for patient and nurse. Finally, the dialogic and embodied engagement expressed by a relational narrative is developed as a critical element of the ethic.

Humans↗

PubMedDate not supplied

Narrative skills of children with communication impairments.

BACKGROUND: Narrative assessment is sensitive to the communication impairments of children with specific language impairment and those with autistic spectrum disorders. Although both groups of children tend to show deficits in narrative, it is unclear whether these deficits are qualitatively different and how language and pragmatic ability may impact on narrative competence. Comparing these two groups of children with children who exhibit pragmatic language impairment without autism may help to clarify these issues. AIMS: This study explored the relationship between structural language ability and pragmatic competence in narrative in children with communication impairments and typically developing children. METHODS AND PROCEDURES: Diagnostic status was determined using the Children's Communication Checklist. All children were asked to generate a narrative to the wordless picture book Frog, Where are You? (Mayer 1969). Narratives were analysed according to their global structure, local linguistic structure and the child's ability to provide evaluative comments, especially about mental or emotional states. OUTCOMES AND RESULTS: No group differences were seen in global structure or evaluation. Children with specific language impairment and autistic disorder made more syntactic errors, and children with autism were significantly more likely to provide ambiguous references in the story. No significant relationships were evident between the Children's Communication Checklist and narrative measures. The complexity of language used was related to evaluation in the clinical groups. CONCLUSIONS: Narrative is a good way of assessing linguistic ability in older children with communication impairments. Core language abilities rather than pragmatic skill or diagnostic status are likely to influence narrative development.

Autistic Disorder↗

PubMed2006

How do newly diagnosed hypertensives understand 'risk'? Narratives used in coping with risk.

BACKGROUND: In many clinical settings, there are concerns about communicating risk effectively in the absence of a clear understanding of what risk means to individuals. OBJECTIVES: To explore the ways in which individuals think about risk in the context of a recent diagnosis of hypertension. METHODS: A qualitative interview study of 11 recently diagnosed hypertensive patients recruited from general practice. RESULTS: Participants presented a 'narrative' about their relationship to risk. Two general types of risk narrative were evident: 'denial' narratives and 'acceptance' narratives (though some examples fall along the spectrum in between). The 'deniers' described risk as something they do not think about, or as applying to others but not themselves. The 'acceptors' described risk as an unavoidable part of everyday life. The use of a 'denial' or 'acceptance' narrative appeared to be independent of the level of understanding of evidence-based hypertension medical risks. Some participants who used a denial narrative also described taking a variety of risk-reducing actions in relation to the new diagnosis. For some people the distancing of risk achieved by the narrative seems to be an important way of coping. CONCLUSIONS: Participants described risk by way of a personal narrative, which functioned as a coping position. The coping position adopted did not presuppose either levels of knowledge, or health-related behaviour. In communicating information about risk, practitioners need to be aware of the use of coping narratives; 'denial' does not necessarily imply lack of understanding or unwillingness to take medically appropriate health-related actions.

Adaptation, Psychological↗

PubMed2004

Expertise or performance? Questioning the rhetoric of contemporary narrative use in nursing.

BACKGROUND: In the early 1980s there emerged in nursing a self-conscious and well-articulated concern to articulate nursing's contribution to patient care. This has fostered the production of a large volume of practice narratives that today form the basis of professional self-understanding. First-person practice narratives are now widely used as the evidence base for nursing expertise, not only in their natural home, the world of interpretative research, but also in the bureaucratic-judicial domain of professional regulation, health care organizations, trades unions and professional associations. AIM: The aim of this paper is to question the use of individual narrative accounts of nursing practice as evidence of nursing expertise. METHOD: We examine the model, method, and continuing consequences of these discursive formations of practice. First, we present a methodological discussion of how personal narratives are produced by the interplay between discourse and subjectivity. Second, we explore clinical narratives of expertise in the work of Patricia Benner and others to uncover the common template for contemporary narrative. DISCUSSION: Narrative production in nursing has led to particular constructions, rather than free representations of practice. It is these particular constructions that we call into question. Rather than viewing these narratives as revelatory of nursing practice, we argue that they place a 'spotlight' on the individual actor - the nurse - with an absence of structural practice context. CONCLUSION: We make the case that treatment of these narratives as individual evidence of expertise fundamentally misunderstands their function and purpose, and reduces the constitution of nursing expertise to the performance of a palatable and highly desirable discourse for a nursing audience.

Clinical Competence↗

PubMed2005

Stories as data, data as stories: making sense of narrative inquiry in clinical education.

BACKGROUND: Narrative inquiry is a form of qualitative research that takes story as either its raw data or its product. Science and narrative can be seen as two kinds of knowing, reflected in the distinction between evidence-based medicine derived from population studies and narrative-based medicine focused upon the single case. A similar tension exists in the field of narrative inquiry between cognitive-orientated analytical methods and affective-orientated methods of synthesis. AIMS: This paper aims to make sense of narrative inquiry in clinical education through definition of 'narrative', articulation of a typology of narrative research approaches, and critical examination in particular of analytical methods, the dominant approach in the literature. The typology is illustrated by research examples, and the role of medical education in developing expertise in narrative inquiry is discussed. An argument is made that the tension between analysis of the structure of stories and empathic use of stories can be seen as productive, stimulating expertise encompassing both approaches. DISCUSSION: Analytical methods tend to lose the concrete story and its emotional impact to abstract categorizations, which may claim explanatory value but often remain descriptive. Stemming from discomfort with more integrative methods derived from the humanities, a science-orientated medical education may privilege analytical methods over approaches of synthesis. Medical education can redress this imbalance through attention to 'thinking with stories' to gain empathy for a patient's experience of illness. Such an approach can complement understanding of story as discourse - how narratives may be used rhetorically to manage both social interactions and identity.

Clinical Medicine↗