Narrative Writing for Health Care Professionals

This sort of workshop has the power to change practice. This is what has always drawn me to research—the notion that I could be a part of projects that might drive improvements in clinical practice—but this weekend’s work has the power to change not just clinical practice but nursing itself. This is no small thing, and deeply needed on so many levels.—A narrative writing workshop participant

Through the CHMP’s program in Narrative Writing for Health Care Professionals, senior fellows Jim Stubenrauch and Joy Jacobson aim to help nursing students and other health care professionals to become more effective communicators—as patient advocates, members of interprofessional health care teams, and policymakers—and more compassionate providers of patient-centered care.

What distinguishes our program is that we seek to achieve these ends by artistic means. We have seen that by engaging student and working clinicians in a process of self-discovery through reflective writing and aesthetic appreciation, they become more invested in improving their expressive skills. Such engagement and investment are crucial. Taking inspiration from the growing fields of narrative medicine and medical humanities, we have found that writing about their personal lives and clinical work can be transformative for nursing students and other clinicians. Indeed, reading literary works and writing reflective narratives have been shown to enhance interpersonal skills, increase job satisfaction and retention, and promote empathy among health care workers.

We teach and lead workshops in a variety of settings:

IN THE HOSPITAL We have provided two kinds of workshops to nurse managers at the University of Medicine and Dentistry of New Jersey (UMDNJ): one focused on improving communication skills and managing stress, another on writing “patient-

Poetry Heals workshop participants at UMDNJ, left to right: Joy Jacobson, MFA; Albert Abdemur, RN; Margaret Quinn-King, RN; Kimberly Griffin, RN; James Stubenrauch, MFA; Gloria Igwe, DNP, RNC; Ingrid Bruce, BSN, RN; Gina Damus, BSN, RNC

advocacy narratives” that show how nurses go “above and beyond” to meet patients’ needs.

An example of the latter: one nurse manager wrote about an injured child whose symptoms indicated inadequately treated pain. Through several sessions of writing the nurse came to realize how extensive her advocacy in this case was. She conferred with a nursing colleague, informed the physician of her concerns, administered newly ordered pain medication, and documented important assessment findings that led to surgery and the detection of internal bleeding. She made sure the parents were involved, and at each step comforted the frightened boy.

This story shows the everyday courage required of clinicians, and the writing process reveals how such acts of advocacy often go unrecognized—and that through writing a clinician can better understand and articulate the importance of his or her work.

We also facilitated a New Jersey Council on the Humanities–sponsored Poetry Heals workshop at UMDNJ, as part of a statewide initiative to bring arts into medical settings.

IN THE CLASSROOM Our writing courses at the Hunter–Bellevue School of Nursing serve a diverse population of undergraduate and graduate nursing students. More than 40% of 2012 graduates were born outside the U.S. and many do not speak English as a first language. Our teaching methods are meant to encourage students to discover their voices, so that they can convey their clinical insights to broader audiences and participate more fully on interprofessional care teams.

Students keep a daily journal, respond to in-class creative writing prompts, and complete a variety of assignments, including a response to a literary text, a blog post, an evaluation of a qualitative research study, a memo to a supervisor, and a narrative essay. All formal writing assignments consist of a first draft and a significant revision. This process of drafting and revising is central to our pedagogical approach; in this we follow the writing teacher Donald Murray: “We are coaches, encouragers, developers, creators of environments in which our students can experience the writing process for themselves.” Students also gain experience in public speaking when they read their work aloud to classmates.

IN THE COMMUNITY Over the past two years, we have led continuing education workshops in a variety of formats for working clinicians, nursing students, and faculty in nursing and other disciplines at Hunter-Bellevue School of Nursing, CUNY Graduate Center, New Jersey City University, and New York City College of Technology. These workshops focus on reflective writing, close reading, and the integration of narrative techniques into nursing and interdisciplinary science and humanities curricula.

In partnership with the Children’s Brain Tumor Foundation, we have also piloted writing workshops for adolescent and young adult survivors of brain and spinal cord tumors and their parents and siblings—a program we hope to expand in the near future.

FACULTY BIOS AND CONTACT INFORMATION
Joy Jacobson is the poet-in-residence and a senior fellow at the Center. Her poems have appeared in Smartish Pace, Beloit Poetry Journal, The Examined Life, and elsewhere. She is also a health care journalist and an editor (she served for a decade as the managing editor of the American Journal of Nursing). In 2008 Joy won an award for excellence in health care journalism from the Association of Health Care Journalists for her report on violence against nurses, and in 2010 she contributed, with Diana Mason, more than 20 “success stories” to The Future of Nursing: Leading Change, Advancing Health, a major report of the Institute of Medicine and the Robert Wood Johnson Foundation. She blogs on poetry and other matters for HealthCetera and holds an MFA in poetry from the New School.

Jim Stubenrauch is a senior fellow at the Center and a freelance writer and editor specializing in health care and education. As an editor at the American Journal of Nursing for nine years, he edited original nursing research and wrote and edited articles on clinical and health-policy topics, including emerging infections, health care reform, and photo essays on international disaster relief. Jim’s writing has also appeared in the Believer, the Los Angeles Times, Oncology Times, and on CHMP’s HealthCetera blog, He was recently named a Friend of Nursing by the Alpha Phi Chapter, Sigma Theta Tau International. He received an MFA from the Writing Division at Columbia University’s School of the Arts.

UPCOMING AND PAST EVENTS
Narratives of Diversity On June 25, we will hold a one-day workshop featuring keynote speaker Deborah Washington, PhD, RN, Director of Diversity for Patient Care Services at Massachusetts General Hospital and clinical instructor at the MGH Institute School of Nursing. This workshop will give nurses—clinicians, faculty, researchers, administrators, and students—an opportunity to explore their experiences with personal, professional, and societal diversity and marginalization. In this interactive workshop we’ll guide participants through exercises involving prompted writing, reading, and sharing of their own stories of diversity and marginalization, while exploring strategies for raising awareness of these issues in their community, workplace, or school. Nurses at all levels of writing skill and experience are welcome. Click here and type in the code NARDIV to register.

Telling Stories, Discovering Voice: A Writing Weekend for Nurses We are offering a three-day intensive writing workshop on July 19–21, 2013, and are planning others for later in the year. This interactive workshop will feature the writing, reading, and sharing of reflective on both personal and professional experiences. We will explore the use of reflective writing as a process of discovery, healing, and self-care. Nurses at all levels of writing skill and experience are welcome. Check back for a URL soon.

Poetry & Conversation with Rachel Hadas & Rita Charon, September 22, 2011.

RELATED BLOG POSTS
Nursing Students as Writers and Nursing Students as Writers, Part 2. Jim Stubenrauch writes about our first class with graduate nursing students.

Health, Media, Policy … and Poetry and Health, Media, Policy…and Poetry, Part 2. What’s poetry got to do with policy? Joy Jacobson explores the intersections.

Calling All Nurse Writers. CHMP advisory council member and New York Times contributor Theresa Brown writes: “I wasn’t a writer before I became a nurse. . . . [O]nly after I became a nurse and then began, almost by chance, writing about nursing, did I find the writerly voice I now have.”

“When I hear my own voice, I . . .” Jim writes about a continuing-education weekend for nurses, in which participants wrote 55-word stories.

Out Loud and In Writing. A guest post by an attendee of a weekend workshop, Patricia Wagner Dodson, who writes that “in this workshop community of real nurses and real writers, a consensus seemed to emerge: the stories need to be told. The workshop was the beginning of the telling.”

PODCAST: The Arts in Health and Healing. Diana Mason interviews Dr. Diane Kaufman (a pediatric psychiatrist at University Hospital, Newark, and director of the hospital’s Creative Arts Healthcare program), Jim Stubenrauch, and Joy Jacobson.

RESOURCES Our courses and workshops encourage participants to explore and refine their powers of observation, description, and expression. Our teaching strategies include in-class guided writing exercises (“quick writes”); discussion of published poems, stories, essays, scientific papers, and blogs; and encouragement to develop a daily writing practice. Please send us an email (jacobsonjoy@gmail.com and jimstuben@gmail.com) if you’d like a list of resources.