Story Middle Range Theory and Nursing Care

Afza.Malik GDA

Nursing Care and Story Middle Range Theory

Story Middle Range Theory and Nursing Care

Whats is Story Middle Range Theory,Assumptions of Theory,Relationship with Person History,Nursing Care and History Theory,Story Theory and Nursing Research,Purpose of Story Theory In Research.

Whats is Story Middle Range Theory

    Story theory, which was originally titled "Artentively Embracing Story" (Smith, M. J., & Lichr, 1999), proposes that story is a narrative happening of connecting with self in relation through nurse-person intentional dialogue to create ease. 

    The authors of this middle range theory recognize story as a fundamental dimension of human experience and nursing practice (Smith, M. J., & Liehr, 2003b). All nursing encounters occur within the context of story. 

    The stories of the nurse, patient, family, and other health care providers are woven together to create the tapestry of the moment-the unfolding story about a complicating health challenge. 

    The idea of story is not new to nursing but has been explicitly or implicitly incorporated into theories, used as an intervention, or as a source of research data (Smith, M. J., & Liehr, 2003b). 

Assumptions of Theory

    Story theory calls attention to the human story as a health story in the broadest sense, structuring concepts to provide one perspective of the place of story in health promotion, The theory is based on three assumptions which underpin the conceptual structure. The assumptions state that people:

(a) change as they interrelate with their world in a vast array of flowing connected dimensions,

(b) live in an expanded present moment where past and future events are transformed in the here and now, and

 (c) experience meaning as a resonating awareness in the creative un- folding of human potential (Smith, M. J., & Liehr, 2003b). 

    The three concepts of the theory are connecting with self-in-relation, intentional dialogue, and creating ease. Intentional dialogue is the central activity between nurse and person which brings story to life as a health-promoting endeavor. 

    Intentional dialogue is querying emergence of a health challenge story in true presence. It is purposeful engagement with an- other to summon the story of a complicating health challenge (Smith, M. J., & Liehr, 2003b). 

    Intentional dialogue demands that the nurse come to the other with full attention to learn the meaning of a complicating health challenge through abandoning preexisting assumptions, respecting the storyteller as the expert who knows the meaning, and querying vague story directions to clarify what is being shared.

Relationship with Person History

    Connecting with self-in-relation occurs as reflective awareness on personal history. It is an active process of recognizing self as related with others in a developing story plot uncovered through intentional dialogue (Smith, M. J., & Liehr, 2003b). 

    To connect with self-in- relation, people see themselves not as isolated individuals but as existing and growing in a context, which includes awareness of other people and times, sensitivity to bodily expression, and a sense of history and future in the present moment.

Nursing Care and History Theory

    In following the story path, the nurse encourages reckoning with a personal history by traveling to the past to arrive at the story beginning, moving through the middle, and into the future all in the present, thus going into the depths of the story to find unique meanings that often lie hidden in the ambiguity of puzzling dilemmas. (Smith, M. J., & Lichr, p. 171)

    Creating ease is remembering disjointed story moments to experience flow in the midst of anchoring (Smith, M. J., & Licht, 2003b). The remembering creates a space of fit where one can anchor even for only a moment. 

    Paradoxically, anchoring is accompanied by flowing as energy surfaces with the coming together of story moments into a comprehensible whole and there is movement toward resolving the complicating health challenge.

Story Theory and Nursing Research

    Story theory comes to life in research and practice through complicating, developmental, and resolving processes, essential elements of all stories.

    When gathering health story data, the com plicating process focuses on a health challenge that arises when there is a change in the person's life; the developmental process is composed of the storyplot that links to the health challenge and suffuses it with meaning; and the resolving process is a shift in view that enables progressing with new understanding. (Smith, M. J., & Liehr, 2003b, p. 173)

    Each time a nurse engages a patient to learn about what matters, story theory is applicable. By abandoning preexisting assumptions, respecting the storyteller as the expert, and querying vague story directions, the nurse intentionally engages the other, enabling connecting with self-in-relation to create ease. 

    When the foremost intention of the nurse is caring-healing, the nurse queries the story about "what matters" to a unique individual culminating in a distinct story of how one person is living a presenting health challenge. The distinct story enables nursing care which is fine-tuned to uniqueness, addressing what is most important from the perspective of the patient.

 Purpose of Story Theory In Research

    A health story gathered for the purpose of scholarly inquiry represents a different fore- most intention. When scholarly inquiry is the intention, the nurse has posed a research question about a particular health challenge and the participant is queried to understand how the health challenge has been lived. 

    Regardless of the intention, caring-healing or scholarly inquiry, stories are gathered with a focus on essential story processes: complicating health challenge, developing story-plot, movement toward resolving. 

    The only quality that distinguishes the caring-healing from the scholarly inquiry intention is where the intentional dialogue begins-either with what matters most as identified by the patient or with a phenomenon addressed in the research question developed by the nurse. 

    Regardless of intention, story-plot can be pursued by drawing structures like a family tree or story path (Smith, M. J., & Liehr, 2003b, p. 175). 

    Likewise, with either intention, movement to- ward resolving is possible as the storyteller is immersed in sharing a health challenge experience with someone who really cares to listen. "Finding a center of stillness and letting go of busyness and distractions energizes mindful attention to the story and propels movement toward resolving" (Smith, M. J., & Liehr, p. 176).

    A story of a health challenge gathered for the purpose of scholarly inquiry demands a research strategy based on a research question. M. J. Smith and Lichr (2003b) propose approaches for qualitative and quantitative analyses of story data. 

    They are pioneering the dual analyses (qualitative and quantitative) of a single set of stories, suggesting that dual analyses may provide the most meaningful direction for practice, further theory development, and continued research. 

    Qualitative approaches for use in dual analyses include any qualitative method in which stories have been gathered and audio-recorded for transcription. Quantitative analysis is accomplished with narrative analysis software, Linguistic Inquiry and Word Count (LIWC), using the transcriptions prepared for qualitative analysis (Smith, M. J., & Liehr).

    Research and practice have contributed to the development of story theory, establishing the middle-range foundation for the theory. Since the theory's publication in 1999, the authors have been developing methods guided by the theory. 

    The real test of any theory, especially a middle-range theory, occurs as it is used to guide practice and re- search. 

    By this criterion, story theory is in early stages of growth, but the theory is well positioned for use by nurses who share a belief about the central place of story for the discipline of nursing and it is well positioned for use with undergraduate and graduate students who are seeking guidance about engaging patients to talk about a health challenge.

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