Approved or disregarded? Exploring arenas for narrative relations in geriatric care

ABSTRACT

Purpose

The use of narration in healthcare has been accentuated as a response to the requested shift towards person-centred care. The notion of narrative relations refers to a process of involving several people in mutual and ongoing narrative exchange. This study aimed to explore how and where narrative relations may be adopted and enacted in everyday healthcare practice.

Methods

The study has a qualitative, explorative design. Seven interprofessional focus group discussions with healthcare staff were prompted by vignettes. A multidisciplinary team of healthcare staff (n = 31) were recruited on a geriatric ward. Data were analysed using a constant comparative method.

Results

A core theme shows how narrative relations are adopted and enacted both as part of an approved practice—the work procedures commonly approved as part of healthcare, and as a disregarded practice where covert but important narrative relations take place to support fundamental qualities of healthcare. Moreover, the findings consider arenas of healthcare practice where approved or disregarded practices are enacted in the clinic frontstage and the clinic backstage.

Conclusions

Narrative relations may take place in different arenas of healthcare practice yet simultaneously become a cohesive force interconnecting those arenas and uphold continuity. Impeded narrative relations in one arena may have unintended consequences in another.

KEYWORDS:

• Geriatric care
• health services research
• interpersonal relations
• interprofessional relations
• narration
• qualitative inquiry
• person-centred care

Acknowledgments

We wish to express our gratitude to the healthcare professionals who generously shared their reflections, experiences and time with us. We are also grateful to our colleagues who have contributed to this work with constructive comments during the process, and to Stockholms Sjukhem Foundation and the Research School in Health Care Sciences at Karolinska Institutet for funding the research.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval and consent to participate

The Regional Ethical Review Board in Stockholm approved the study (reference number 2019–00248). All participants received written and oral information about the study and about how data was managed and gave their written informed consent to participate. The study complies with the national legislation of Sweden where the study was performed.

Author contributions

First author: Conceptualization, Formal analysis (qualitative), Investigation, Methodology, Writing original draft, Writing—Reviewing and Editing, Visualization.

Second author: Conceptualization, Formal analysis, Funding acquisition, Methodology, Resources, Writing—Reviewing and Editing. Supervision.

Third author: Conceptualization, Methodology, Formal analysis, Funding acquisition, Project Administration, Writing—Reviewing and Editing. Supervision.

Last author: Conceptualization, Formal analysis (qualitative), Investigation, Methodology; Funding acquisition, Writing—Reviewing and Editing. Supervision.

Availability of data and materials

The data that support the findings of this study are available on reasonable request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Additional information

Funding

This work was supported by Stockholms Sjukhem Foundation and the Research School in Health Care Sciences at Karolinska Institutet.

Notes on contributors

Lisa Herulf Scholander

Lisa Herulf Scholander is a researcher in the field of health care sciences. Dr. Herulf Scholander has a research focus on person-centred healthcare practices and interprofessional relations in geriatric care, and an interest in narrative approaches in research and practice. Her current research is concerned with the everyday conditions for narrative practices in geriatric care.

Anne-Marie Boström

Anne-Marie Boström is an Associate Professor in nursing with a focus on health and well-being for older persons with or without dementia. Dr. Boström is conducting research on the dissemination and implementation of research findings and evidence in the care of older adults.

Staffan Josephsson

Staffan Josephsson is a Professor in occupational therapy with a focus on narrativity in and health and social care. Dr. Josephsson is conducting research on everyday life for older persons living with health and social issues.

Sofia Vikström

Sofia Vikström is a Senior lecturer in occupational therapy with a focus on health and well-being for older persons in health- and social care and their family caregivers. Dr. Vikström is conducting research on knowledge translation and support methods towards family caregivers, and staff in care of older adults at home or in health-/health- and social care settings.