Wading in the Water: A Case Study Approach to Engaging More Fully in the Patient Narrative

Abstract

Working in the patient narrative has become a familiar part of the common language used in the context of caring for patients. Working in the patient narrative encompasses sharing conversation that allows exploration of the entire patient experience as it relates to health and illness. However, the complexity of engaging in end-of-life conversations, standing steady with conflict, remaining present, maintaining neutrality, and actively listening remain challenging concepts in practice even though they are integral to effectively doing so. Literature review has identified and defined key elements of interactions that can lead to significant opportunities to “wander more fully” in the patient narrative. Two case studies reviewed therein demonstrate ways in which palliative care encounters and end-of-life discussions afford the interdisciplinary team members purposeful engagement with patients. One case discusses taking risks to delve more deeply into patient's fears related to dying. This exploration lays the foundation for assuring goals of care are aligned with individual patient values. The other case demonstrates the use of symbols to share dialog related to an individual's tasks of dying. When directed, intentional facilitation occurs, the patient's unique holistic needs and values are identified, and goals of care can be clarified. In conclusion, highlights of research and clinical applications provide advantageous practice implications.