Concepts in Story Theory

1. Intentional Dialogue – the central activity between nurse and person that brings story to life, it is
querying emergence of a health challenge story in true presence (Smith & Liehr, 1999). True
presence is fully immersed way of being with another, where authenticity and mindfulness
prevail. This purposeful engagement with another creates potential for embracing the whole story
in the moment as the nurse summons the storyteller’s narrative focusing on the matter most
about the complicating health challenge (Smith & Liehr, 2014). Human experiences may be similar
in context but in the moment each person have unique experience that makes each experience
unique in one way another. These complicating health challenges hurdles life changes that creates
uneasiness. And acknowledging the emerging uneasiness will help nurse create a significant
interaction with its client. The nurse can never assume to know what matters most about the
health challenges regardless of the extent of experience in a particular practice environment
(Smith & Parker, 2015).

2. Connecting with Self-in-Relation – occurs as reflective awareness on personal history (Smith &
Liehr, 1999). It is an active process of recognizing self as related with others in a developing story-
plot uncovered through intentional dialogue (Smith & Liehr, 2014). 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. As the nurse continues to gather bits of the
whole story that the client have regarding with its current health challenges, the nurse should
also explore the past history in relation with the present health challenge and also tackles the
future thru hopes and dreams related to it as well. When using 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 meaning that often lie hidden in the ambiguity of puzzling dilemmas (Smith & Liehr,
2014).

3. Creating Ease – defined as remembering disjointed story moments to experience flow in the midst
of anchoring (Smith and Liehr, 1999) to an understanding of the whole story (Smith & Parker,
2015). As the bit of the history of the client is being surface in the context of story plots, self-
ventilation or easiness is situated in the complex context. As the bits of story connects in such a
way that the client expresses, a pathway is created towards resolution of the health challenge.

References
Smith, M.C. & Parker, M.E. (2015). Nursing Theories and Nursing Practise (4th Edition).
Philadelphia: F.A. Davis

Smith, M.J. & Liehr, P. (1999). Attentively embracing story: A middle-range theory with research
and implications. Scholarly Inquiry of Nursing Practice: An International Journal, 13, 187-204

Smith, M.J. & Liehr, P. (2014). Middle range theory of nursing (3rd Edition). New York: Springer.
Case Study

Mr. Cruz is a 43 years old client currently admitted in a Psychiatric Facility. He was diagnosed with Bipolar
Affective Disorder with current medication of Lithium Carbonate 450mg BID and Olanzapine 10mg HS. He
was brought to the facility due to auditory hallucination, sleeplessness and with disrupted behaviour.

The nurse establishes rapport to the client and conducts series of interview the following are significant
story plots that the nurse identify. Mr. Cruz is the 8th siblings in 11 children. His parent are too old to take
care of him. At the age of 5, Mr. Cruz was brought to his eldest brother together with his younger brother.
He remembered being punished and forced to do farm works at an early age. He stated that, “kung hindi
kami magtratrabaho ng maigi di kami kakain” (It was like if we don’t work we will not be able to eat). He
also remembered being bullied by his classmate whenever they so him sun drying their “palay” on the
court in front of their house. He also stated that he and his brother where brutally punished by his elder
brother that in a point his brother’s belt was broken and brought a “yantok” stick for them. He was not
able to finish college due to refusal of his family to support his studies.

He was married with two children. He worked as a project manager in a construction company for almost
5 years and he applied for a promotion but didn’t get it due to his educational background and because
of that he stated that all his childhood experience where hunting him and causes depression in his part.
But his wife was able to support him that he survive his depression. Mr. Cruz also stated that he had an
affair with his co-worker, his wife was able to forgive him but he can’t forgive himself. He resigned to that
company and he started his own business together with his wife. They have a construction business and
because of that they were able to live comfortably. He was able to buy properties.

A project was given to him by a church mate to build a house in an exclusive subdivision. Due to some
circumstances, he was fooled by his church mate. The church mate was promising amount of money that
he will pay if Mr. Cruz will be able to finish the project. Mr. Cruz use his own money to build the project
even to the point that he was selling his properties. But in the end he was bankrupt and he was not able
to be paid by his church mate. He was then depress without knowing what future will lead him and his
family.

His brother was able to help him. He was able to borrow his brother’s car and use it for Uber. He started
driving at 4am in the morning until in the midnight. He was stress because have to be able to get his
boundary. Then later on due to family problem, Mr. Cruz when on mental breakdown and then brought
to a psychiatric but refuses to take his medication. He was having verbal and physical argument towards
his wife to the point that he wanted to kill his wife and himself. The client was then brought to the
psychiatric facility.

As the psychotherapy (both group and individual) was given to the client by the psychiatric nurse, the
client was able to understand himself better. The psychiatric nurse was able to create individualized plan
of intervention to the client. Identification of significant life events that contributed to the current health
challenge, the nurse was able to deeply understand the situation of the client. Self-ventilation was
achieved in the process as sense of easiness and the client verbalizes his future hopes when he will be
discharged in the facility that he will take his medication and fix his relationship with his wife and children.
The client started having conflict resolution towards the primary family his wife and children.
Insight

“Human is created by his story not by its parts or structures”. Each person may have similar experience
but have different way in explaining the experience making in unique. Uniqueness of an individual’s story
enables the nurse to create client-centered and individualized intervention.

As a psychiatric nurse for almost 4 year now, application of the story theory is very workable and relatable
since I am dealing with the client’s experiences which involves his emotions and behaviour. Dealing with
lived-experience experiences or human phenomena can also affect not only the client but also nurse itself
so it is also important the nurse should started dealing with itself or undergo process of self-awareness.
Human experience is very complex that it involves different layer of human phenomena. Undergoing
series of interviews and establishing rapport may sound easy but the true process lasted for weeks and
months in my case handling psychiatric client. Personality of the client can also be a factor in acquiring
such data.

As different body of knowledge interplay with the human being nurses are force to broaden their
knowledge, skills and attitude to be able to give holistic care to our client. And human is also changing
with its world and so as nursing it is real no constant thing in the world except change.

Theoretical model of the Story Theory

The theoretical model above shows the relationship among the concepts of the story theory namely:
Intentional dialogue, Connecting with self-in-relation and Creating ease. A wave that intercepts the across
all the concepts shows how essential the story-sharing or story-telling thru intentional dialogue. The
intentional dialogue intercepts connecting the nurse and the person and then creates another
interception with connecting self-in-relation and creating ease. As the nurse engage with the person thru
intentional dialogue focusing in the health challenges that the person is currently facing and from there
connecting self-in-relation take place as the nurse develops a story plot by connecting the past life events
that contribute to the present health challenges and discover future hopes and dreams related to it and
in the process creating ease will sits in as meaningful movements of resolving health challenges take in.

James Patrick Valera, RN

Head Psychiatric Nurse/Training Supervisor
Livelife Homecare Inc., Laguna, Phillipines