Narrative medicine program

The narrative medicine program was divided into two parts: theoretical education and clinical practice education. The students in Group 2 received theoretical education only. For the junior students, the course occurred during the spring term and lasted for 4 months. The courses were conducted by a teacher well trained in narrative medicine. Students had 12 weekly sessions that comprised an hour-long class. The class consisted of narrative medicine theory, observation and discussion of movies, and reading and analysis of medical narrative books.²¹ The main reference book for the theoretical education was Narrative Medicine: Honoring the Stories of Illness, written by Rita Charon.¹⁵ The movies were Wit, Tuesdays with Morrie, and Patch Adams. The books were The Illness Narratives: Suffering, Healing & the Human Condition, by Arthur Kleinman; The Wheel of Life, by Elisabeth Kubler Ross; The Grace in Dying: How We Are Transformed Spiritually as We Die, by Kathleen Dowling Singh and How We Die: Reflections on Life’s Final Chapter, by Sherwin Bernard Nuland. The students were required to closely read the books and watch the movies after class. During the class, the teacher and the students discussed the stories and analysed their meaning. The aim of the discussion was to help students try to understand the patients’ experiences and develop a deeper understanding of the meaning of medicine. Key words and phrases used in the course were ‘company’, ‘empathy’, ‘holistic care’ and ‘life and death’. The course focused on helping students to gain a preliminary understanding of narrative medicine and to develop their narrative abilities. The course grade was composed of group reports (six people per group) and research papers. The students’ grades could replace an optional course grade, which was earned during the same class hour.

The students in Group 3 received both theoretical education and clinical practice education. These students received the same theoretical education as those in Group 2. The clinical practice education occurred during the autumn term, from September to December, when the students were in graduate class and beginning clinical practice. Their mentors were teaching nurses who had been trained in narrative medicine. The students were divided into groups (10 students per group) with one mentor per group. First, the students were asked to listen to the patients’ stories and respond to their narratives. The key focus in this part of the class was parallel chart writing. Students were required to write the patients’ parallel charts according to the patients’ narratives; the parallel charts supplemented the standard medical records and included the patients’ life situations, physical feelings and psychological and social needs. The parallel charts emphasised social, cultural and ethical aspects.²² Then, the team members shared the patients’ stories and explored the patients’ multiple needs. Second, both the nursing students and the patients wrote and exchanged diaries. In the diaries, students wrote about the patients’ physical and mental trauma and built an understanding of them and a dialogue with them. This approach was aimed at helping them to develop deeper, high-quality nurse–patient communication and construct a community based on emotion, morality and personal values. The range of dimensions on which the students helped the patients could be expanded according to the patients’ needs.²³ Third, students were asked to perform reflective writing to review and interpret their experiences.²⁴ The cases included several first experiences in clinical practice, such as the first time in charge of a patient and participation in surgery. Moreover, the students could include information about the patients who impressed them, the process of their communication with the patients and their own experiences with illness, as well as their thoughts about the patients, medical care or their medical career journey. The mentors encouraged the students to adopt diverse forms of expression, such as prose and poetry. Through reflective writing, the students re-examined the nurse–patient relationship and the role of the nurse; consequently, their nursing-related thought processes and their relational and ethical competence were optimised. The aim was to develop students’ critical thinking, and importance was attached to the emotional dimensions of both the patients and the students. In this way, students could achieve a deeper understanding of care and a guide for their future behaviour. In this program, students were asked to complete two parallel charts, exchange diaries with one patient and write two reflective papers. In addition, each team held a 2-hour seminar once every 2 weeks, during which they discussed their clinical work, writing and experience, and shared their introspections.²⁵ For the final report, each group gave a presentation about what they had learned from the program; they shared their thoughts about the patients’ feelings and discussed ways to provide humanistic care. The teachers who conducted the theoretical and clinical education reviewed these presentations and scored the groups according to their performance in the learning process, the assignment and the presentation. The group that performed the best was rewarded.