Telling Stories is Key to Improving Practice and Care, Nurse Leader Says

    • May 8, 2015

The United States of America was Mingzhu’s last hope. A 6-year-old boy with abdominal cancer, Mingzhu had not responded to treatment in China, his home country, so his parents and grandparents had flown him to Boston in the hope he would fare better here.

Mingzhu sought treatment at Massachusetts General Hospital (MGH) but, sadly, succumbed to the disease. He was, however, able to pass away in comfort due to culturally sensitive care from Janet Actis, RN, a pediatric nurse, and her team at MGH.  

While caring for Mingzhu, Actis made an effort to learn about and understand Chinese beliefs and end-of-life practices so the care team could meet the cultural needs of Mingzhu, his mother—who was eight months pregnant at the time—and his father and grandparents.

She helped arrange for Mingzhu to see a sonogram of his unborn sister, granting him his last wish. She helped wash and dress Mingzhu in preparation for the Chinese afterlife. She helped find a way to allow Mingzhu to stay in the unit for 24 hours after he had passed away so his family could have the time they needed to grieve according to their customs.

Actis tells this story in a new book about the value of first-person narratives in health and health care. “I now understand the impact nurses can have by going the extra mile, supporting one another, and providing care that’s culturally competent and sensitive,” she writes.

Actis’ story is one of about 30 “clinical narratives” that appear in Fostering Clinical Success: Using Clinical Narratives for Interprofessional Team Partnerships From Massachusetts General Hospital, a new book published by Sigma Theta Tau International.

The stories are written by nurses, therapists, and social workers, and cover themes including the clinician-patient relationship; learning to care for family members; clinical knowledge and decision-making; teamwork and collaboration; and the importance of physical movement. Commentaries and reflective questions appear at the end of each story.

‘Labor of Love’

Lead author Jeanette Ives Erickson, DNP, RN, NEA-BC, FAAN, senior vice president for patient care and chief nurse at MGH and an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (1998-2001), called the book a “labor of love.”

“Many days,” she said in an interview, “it feels like health care is under siege. We have to demonstrate outcomes, provide data, and reduce costs. But at the end of the day, we all work in health care because of the human connection, because we want to do good. We need to talk about the good that’s happening in health care.”

Doing so—through the reflective practice of writing and sharing first-person clinical narratives—can improve patient care, reduce costs, and increase patient, family, and staff satisfaction, she and her co-authors argue. These kinds of stories can help providers, patients, and the public understand the richness of practice, improve communication among colleagues, and increase the visibility of nursing and other professions, she said. Stories that involve mistakes or near-mistakes also help improve quality and safety, she added.

In the book, Ives Erickson aims to show administrators how to create and embed a “narrative culture” in health care organizations. Ives Erickson speaks from experience; two decades ago, she spearheaded an initiative at MGH to use clinical narratives in programs relating to rewards and recognition, clinical advancement, and performance evaluations, an idea that came from noted nurse leader Patricia Benner, PhD, RN, FAAN.

The narrative culture is now deeply embedded at MGH and in other health care organizations across the country, and other groups are working to spread the word about its value. Earlier this year, with support from RWJF, the Business Innovation Factory created a “playbook” to promote storytelling as a way to improve health and health care. At MGH, nurses write stories about their experiences with patients for their annual reviews, when seeking promotions, and for a hospital publication.

Ives Erickson’s co-authors are Marianne Ditomassi, DNP, RN, MBA, executive director of patient care and Magnet recognition at MGH; Susan Sabia, BA, executive editor of Caring Headlines, a biweekly newsletter for MGH nursing and patient care services; and Mary Ellin Smith, RN, MS, professional development manager at the MGH Institute for Patient Care.

The book is the second in a series of three by Ives Erickson. In 2012, she and her co-authors published Fostering Nurse-Led Care: Professional Practice for the Beside Leader from Massachusetts General Hospital. Later this year, she will release a third book about nurse research.