Patient Stories as part of EoC Project

“We are so used to thinking of research as providing a special kind of methodologically validated knowledge about society that it’s not easy to accept the notion of research as story-telling. We think of story-telling as ‘unserious’, as fictional, whereas the dominant image of research is that it is about finding the ‘truth’ and therefore an altogether more serious business.”[1].

Purpose

The aim of the collections of stories is to illuminate the essentials of care nursing framework from patients’ perspectivesand theorise about the common elements that make a better patient journey.

Patient stories portray how being a patient is different for each individual patient. It can be challenging to accept that any account of research is explained through the notion of a story. Each patient story constructs a truth and there are multiple truths or realities about being a patient in hospital. This part of the project is researching the experience of being a patient and how this could inform the essentials of care nursing framework. It challenges the leading assumptions of the positivist/empiricist research tradition that claims:

  • Observation is value-neutral, a-contextual and a-theoretical
  • A uniform and transparent language is possible
  • Data is independent of its interpretations

The patient stories create a worldview and understandings from a person perspective. Narrative knowledge is contextual, value-explicit and embedded in personal history. Empiricist knowledge is detached from self, factual-objective and potentially meaningless for individual cases.

Technical considerations for patient interviews

  • How to gain access to interviewee
  • How to negotiate time and place for interview to ensure privacy
  • Explain that you are not taping but taking notes

Interview approach

  • This is not a nursing assessment interview
  • This is not a job interview
  • The patient story interview is an opportunity to hear the opinions, experiences, perceptions, fears and hunches of patients, their families and carers.

Interviewer – Interviewee relationship

It cannot be emphasised enough that the substance and quality of the story collected depends almost entirely on the interpersonal relationship between the interviewer and interviewee. You can build rapport by explaining the purpose of this interview, respecting, listening and not judging the interviewee. You want to let your interviewee know that what they are saying is important to us. It is important to explain to the interviewee that we do not want to hear the right and wrong thing. We actually do not judge what they think; we simply want to hear their authentic, sincere story from their perspective. Knowing has roots in cognitive-neurological construction as well as in cultural social (language) interactions. What people actually experience in hospital is interpreted from different angles. We really want to here the patient angle. So we are searching for facts and events and their interpretations of it. Your aim is to hear their perceptions and interpretations. Therefore, consider when conducting interviews:

  • Already established relationship?
  • Compatibility of age, gender, professional position
  • If you are bilingual, make use of it

Some general tips

  • Be non-judgmental
  • Be attentive and listen at all times
  • Ask questions that invite the interviewee to talk and tell their story
  • Only ask one question at a time

Question design

From broad and open to narrow and specific: Open questions are questions that cannot be answered with yes or no. Start with broad questions. Broad questions ask for descriptive answers such as:

  • What is it like for you being a patient?
  • How do you let staff know what you need, what concerns you and what pleases you?

Follow descriptive questions with probing questions. The aim is to find out more detail. You want to understand better your interviewee’s way of thinking, reasoning and values behind their statements and descriptions. We as interviewer invite interviewees’ assumptions to be exposed, we invite them to explain themselves, to reason aloud. As the interviewer we are non-judgmental, almost like a naïve listener. We may ask for clarification, ask for examples, expansions of any assertions they are making, we can tell them back what we understood they have said. Probing questions help clarify understanding and meaning such as:

  • How interesting can you tell me more
  • Let me just summarise this to check I got it right …
  • You said, nurses respect you. Could you give me an example?
  • I am not sure what you meant when you said … could you explain a little more?

Open Questions

Advantages / Disadvantages
Reveals what is important to interviewee / Consumes a lot of time
What information do they volunteer? Collects unanticipated info / Rambling answers are difficult to code
Reveals uncertainty, intensity of feeling, prejudice and stereotypes
Appears less threatening to interviewee

Closed questions

Advantages / Disadvantages
You can ask lots of questions in a short time / Omits detailed info
You have control over the interview content / Does not reveal ‘why’ answers
Easy to code / Interviewee can answer without understanding the topic

Prepared by Diversity Health, Prince of Wales Hospital, Sydney

Version 1 dated 26 August 2014

[1]Usher R 2001. Telling a story about research and research as story-telling: postmodern approaches to social research, in Paechter A, Preede M, Scott D and Soler J (eds), Knowledge, power and learning, Paul Chapman Publishing and The Open University, London, chapter 4, pp.47-55.